Impact on Quality of Life after Treatment with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

Background and Objectives@#Several studies have assessed the impact of laryngopharyngeal reflux disease (LPRD) on the health-related quality of life (HR-QoL), showing significant impairment of HR-QoL. This study aims to assess the impact of proton pump inhibitor (PPI) treatment of LPRDs to enhance HR-QoL.Subjects and Method We prospectively collected data from LPRD patients from April 2017 to July 2019. Patients who have reflux symptom index (RSI) of ≥13 or reflux finding score (RFS) of ≥7 were enrolled in this study. We assessed HR-QoL using a questionnaire with EORTC QLQ-H&N35, -C30 on the first visit. Patients were treated with PPI (Ilaprazole 20 mg/day) on their visits at 4, 8, and 12 weeks. RSI and RFS were measured at each visit and HR-QoL was reevaluated on the last visit. @*Results@#Ninety-five patients completed the 3-months follow-up and were enrolled in this study. Female : male ratio was 71:24 and the mean age was 57.0±11.9 (27-80). The initial RSI and RFS were 16.3±8.8 and 12.6±2.9, respectively, but were changed to 11.1±9.7 and 9.7±2.6 (p<0.001 in both) at 12 weeks after the treatment. Global health status/QoL, speech problem, dry mouth, and coughing were significantly improved. @*Conclusion@#PPI administration is effective in treating LPRD, where effects begin to appear at 4 weeks after treatment. HR-QoL was also improved in patients who have RSI improvement.

Intrathyroidal Parathyroid Carcinoma in Chronic Kidney Disease: A Case Report and Review of Literature / 대한이비인후과학회지

When parathyroid carcinoma occurs in the thyroid gland, it is very difficult to diagnose before surgery because imaging studies and aspiration cytology cannot distinguish parathyroid carcinoma from thyroid nodule or benign parathyroid disease. A 53-year-old male was referred to our hospital for assessment of hypercalcemia. He had suffered from chronic kidney disease for 13 years. A 2.5×1.5 cm hypoechoic nodule was noted in the left thyroid gland on ultrasonography, and it showed increased uptake on the sestamibi scan. Fine needle aspiration biopsy revealed it to be a parathyroid lesion, which was confirmed by surgery as parathyroid carcinoma completely surrounded by normal thyroid parenchyme. Because ultrasonography and aspiration cytology have only a limited role in distinguishing parathyroid carcinoma from thyroid neoplasm, suspicion of parathyroid carcinoma before or during surgery through careful examination can lead to complete resection at the initial surgery.

Risk Factors and Clinical Features of Recurrent Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Benign paroxysmal positional vertigo (BPPV) is treated with appropriate canalith repositioning procedures, which are very effective for the treatment of BPPV. Nevertheless, the recurrence of BPPV may occur after the initial successful treatment. The purpose of this study was to investigate the risk factors and clinical features of recurrent BPPV.SUBJECTS AND METHOD: The retrospective study was performed for 227 patients who were diagnosed with BPPV and treated with appropriate canalith repositioning procedures from March 2013 to December 2014. We analyzed various clinical characteristics, locations and types of canalith for the whole BPPV patients, and the interval and frequency of recurrence in the patients of recurrent BPPV.@*RESULTS@#Of the total of 227 BPPV patients, 47 patients were recurrent BPPV (21%). The patients of recurrent BPPV were significantly older than those of non-recurrent BPPV (p=0.034). BPPV patients recurred more with increased age, with the significantly increased frequency of recurrence (p=0.010). Twenty two patients were posterior semicircular canal canalolithiasis (PSCC) (46.8%) and 25 patients were lateral semicircular canal canalolithiasis (LSCC) (53.2%). The number of canalith repositioning procedures was significantly higher in LSCC patients than in PSCC patients (p=0.041). The location change of affected canal were identified for 23 patients and the type change of LSCC to ipsilateral PSCC was the most common.@*CONCLUSION@#Age is an important prognostic factor to be considered in BPPV recurrence. Also, the affected semicircular canals were frequently changed in the recurrent BPPV.

Caution warnings are required for the sale of neodymium magnets in Korea

Recent reports indicate that the number of children presenting to the emergency department after ingesting magnets has increased over the last decade. Since neodymium magnets became commercially available, reports of complications caused by their ingestion have accrued in Korea. Neodymium magnets are tens of times stronger than ordinary magnets; hence, complications associated with their ingestion are severe. These “super magnets” can be purchased without any restriction. We report the case of a healthy 4-year-old girl who ingested multiple neodymium magnets. The magnets were attached to each other, with the lower esophageal sphincter trapped between them. Endoscopic removal failed, and surgical intervention was required. Unlike ordinary magnets, endoscopic removal of neodymium magnets is difficult due to their strong attraction to each other. In order to prevent potentially tragic accidents and their subsequent surgery, a cautionary warning is essential on toys containing neodymium magnets, to inform the public of the increasingly evident dangers of these “super magnets.”

Risk Factors and Clinical Features of Recurrent Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is treated with appropriate canalith repositioning procedures, which are very effective for the treatment of BPPV. Nevertheless, the recurrence of BPPV may occur after the initial successful treatment. The purpose of this study was to investigate the risk factors and clinical features of recurrent BPPV. SUBJECTS AND METHOD: The retrospective study was performed for 227 patients who were diagnosed with BPPV and treated with appropriate canalith repositioning procedures from March 2013 to December 2014. We analyzed various clinical characteristics, locations and types of canalith for the whole BPPV patients, and the interval and frequency of recurrence in the patients of recurrent BPPV. RESULTS: Of the total of 227 BPPV patients, 47 patients were recurrent BPPV (21%). The patients of recurrent BPPV were significantly older than those of non-recurrent BPPV (p=0.034). BPPV patients recurred more with increased age, with the significantly increased frequency of recurrence (p=0.010). Twenty two patients were posterior semicircular canal canalolithiasis (PSCC) (46.8%) and 25 patients were lateral semicircular canal canalolithiasis (LSCC) (53.2%). The number of canalith repositioning procedures was significantly higher in LSCC patients than in PSCC patients (p=0.041). The location change of affected canal were identified for 23 patients and the type change of LSCC to ipsilateral PSCC was the most common. CONCLUSION: Age is an important prognostic factor to be considered in BPPV recurrence. Also, the affected semicircular canals were frequently changed in the recurrent BPPV.

Male pseudohermaphroditism with os clitoris in three dogs

Two American Cocker Spaniels and one Bichon Frise were presented to our veterinary teaching hospital with an enlarged clitoris. Diagnostic imaging showed that the structure was composed of bony material. Exploratory laparotomy revealed uterine-like structures and testes which had an epididymis unilaterally. Surgical removal of internal genitalia, gonads and protruded clitoris were performed well. Histological evaluation revealed; inactive testes, female internal genital tracts with ambisexual ductal remnants, and prominent ossification in the clitoris. All 3 cases were diagnosed with male pseudohermaphroditism. In author's knowledge, this is the first report in Bichon Frise dog with os clitoris and also, it describes not common cases in small dog breeds with os clitoris.

Dynamic Contrast-Enhanced CT Findings of a Extrapleural Solitary Fibrous Tumor in the Spleen: A Case Report and Literature Review

Extrapleural solitary fibrous tumor, formerly referred to as “hemangiopericytoma” is a rare soft tissue vascular tumor which has elevated malignancy potential arising from the capillary pericytes. Extrapleural solitary fibrous tumors, originating from the spleen, are extremely rare. We report on a rare case of a patient presenting with splenic extrapleural solitary fibrous tumors with intratumoral irregular calcification detected by dynamic contrast-enhanced computed tomography.

Migration and invasion of drug-resistant lung adenocarcinoma cells are dependent on mitochondrial activity

A small proportion of cancer cells have stem-cell-like properties, are resistant to standard therapy and are associated with a poor prognosis. The metabolism of such drug-resistant cells differs from that of nearby non-resistant cells. In this study, the metabolism of drug-resistant lung adenocarcinoma cells was investigated. The expression of genes associated with oxidative phosphorylation in the mitochondrial membrane was negatively correlated with the prognosis of lung adenocarcinoma. Because the mitochondrial membrane potential (MMP) reflects the functional status of mitochondria and metastasis is the principal cause of death due to cancer, the relationship between MMP and metastasis was evaluated. Cells with a higher MMP exhibited greater migration and invasion than those with a lower MMP. Cells that survived treatment with cisplatin, a standard chemotherapeutic drug for lung adenocarcinoma, exhibited increased MMP and enhanced migration and invasion compared with parental cells. Consistent with these findings, inhibition of mitochondrial activity significantly impeded the migration and invasion of cisplatin-resistant cells. RNA-sequencing analysis indicated that the expression of mitochondrial complex genes was upregulated in cisplatin-resistant cells. These results suggested that drug-resistant cells have a greater MMP and that inhibition of mitochondrial activity could be used to prevent metastasis of drug-resistant lung adenocarcinoma cells.

A Case of Salivary Gland Choristoma Mimicking Glomus Tympanicum / 대한이비인후과학회지

Salivary gland choristoma is defined as the architecturally normal salivary gland tissues found in abnormal locations. Middle ear salivary gland choristoma usually presents with conductive hearing loss. We present a case of middle ear mass with conductive hearing loss in a 6-year-old boy. A reddish mass was incidentally found behind the normal tympanic membrane. Magnetic resonance image showed the markedly enhancing lesion which was in accordance with glomus tympanicum. Preoperative angiography was performed, but supplying artery and mass was not identified. Surgical exploration was made and the mass was dissected easily without profuse bleeding. Final diagnosis was salivary gland choristoma by histopathology. We discuss the clinical features and management of middle ear salivary choristoma with the review of literature.

Comparison of Modified Blair Incision and Modified Facelift Incision in Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Modified Blair incision (MBI) and Modified facelift incision (MFI) are mainly used for paroidectomy. MBI can provide a wide surgical view for parotidectomy. MFI was designed for better cosmesis by hiding the incision behind the auricle and hair line. This study was performed to evaluate surgical outcomes, functional and cosmetic results after parotidectomy using MBI and MFI. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 120 patients who underwent parotidectomy from September 2005 to April 2012. Tumor characteristics, operative outcome, and cosmetic outcome according to incision method were investigated. Cosmetic satisfaction was assessed using a questionnaire 12-18 months after surgery. RESULTS: Tumor characteristics such as size, location and pathologic features did not differ between the two groups. The extent of parotidectomy, operation time, amout of drainage, and complications were also not different between the two groups. Cosmetic satisfaction was significantly supeior in the MFI group than that of the MBI group. CONCLUSION: MFI is superior to MBI for parotidectomy for having similar surgical outcome but better esthetical success compared to MBI.

Occupational Stress and Depressive Mood Among Interns and Residents; Relationship between Occupational Stress and Depressive Mood Among Interns and Residents in a Tertiary Hospital, Seoul, Korea

PURPOSE: Occupational stress can have a negative effect on the worker such as physical, emotional, and psychological health. Although it is well reported that health service staff tend to have a high level of minor psychiatric disorder, only a few studies have been reported in Korea. Intern and Residency (residents) are very vulnerable periods of stress and other psychiatric disorders. In this study, we describe occupational stress of interns and residents and relationship between occupational stress and depression. METHODS: The participants of this study were interns and residents trained in a tertiary hospital in Korea. The occupational stress scale was used for measurement of occupational stress. In addition, the Korean version of the Beck depression scale was used to evaluate the prevalence of depression. Statistical analyses were performed using SPSS v. 18.0; p-value less than 0.05 was considered statistically significant. RESULTS: Female doctors showed higher occupational stress than male. Interns and chief residents demonstrated higher occupational stress than other grades. Astonishingly, most participants showed depressive mood. Compared with the general population, job demand and culture of the workplace are in the first upper quartile. It is indicated that compared with general populations, physicians have a higher workload and patience is required in order to cope with the harsh culture of the workplace. Depressive mood was evaluated with various factors and only occupational stress was statistically significant. CONCLUSION: Overwhelming occupational stress of residents could result in both medical and social problems. Therefore, recognition of occupational stress is essential and aggressive interventions are required.

Clinical Characteristics and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss in Old Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In aging society, interest in idiopathic sudden sensorineural hearing loss (ISSNHL) in elderly have been increased. However, as there has been little discussion about prognostic factors of ISSNHL in old age, this study aims to investigate clinical factors related with prognosis of ISSNHL in elderly and compare with that in adults. SUBJECTS AND METHOD: A retrospective medical chart review was performed in patients over 19 years old who diagnosed with ISSNHL from Jan. 2010 to Dec. 2012. Patients were categorized into the old age group (over 65 years old, n=62) and the control group (aged 19 to 64 years old, n=218). Clinical findings, audiological result and treatment outcomes were compared between two groups. And possible prognostic factors of SSNHL in elderly were also investigated. RESULTS: Significant difference of hearing recovery was identified between the old age group (33.9%, 21/62) and control group (50.9%, 111/218) according to Siegel's criteria (p=0.021). Multivariate analysis concluded that delayed treatment and low speech discrimination score (SDS) might lead to poor prognosis in elderly. The presence of tinnitus or dizziness, audiometric configurations, hypertension and diabetes mellitus did not affect the treatment results of ISSNHL in the old age group. CONCLUSION: Onset of treatment and initial SDS could be possible prognostic factors of ISSNHL in elderly. Early diagnosis and urgent treatment are more important in old age.

The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer / 한국유방암학회지

PURPOSE: This study was aimed at evaluating the recurrence rate and recurrence patterns after surgically treating for patients with operable breast cancer. METHODS: From 1992 to 2002, 3700 patients with breast cancer (stages 0-3) who underwent mastectomy or breast conservation surgery at Asan Medical Center, Seoul, were selected for this retrospective study. We analyzed the recurrence rate, the annual hazard rate, the risk factors, the time to recurrence and the recurrence patterns according to the clinicopathologic factors. RESULTS: During the median follow-up period of 45 months, 523 patients (14.1%) of the total 3700 patients developed recurrences: locoregional recurrences occurred in 148 patients (4.0%), distant recurrences occurred in 319 patients (8.6%), and both types occurred in 56 patients (1.5%). The 5-year and 10-year recurrence rates were 17.7% and 23.4%, respectively. The recurrence rate increased in proportion to the cancer stage. The annual hazard rate for recurrence had a peak at 2-years of follow-up. On multivariate analysis, the stage, progesterone receptor status, and c-erbB2 expression were the independent risk factors for recurrence. The median time to recurrence among the patients with recurrence was 24.0 months. 50.5% of recurrences were found within 2 years and 92.0% of recurrences were found within 5 years after surgery. A short time to recurrence was significantly associated with an increased stage, a negative progesterone receptor status, and locoregional recurrences. The common recurrence sites included the chest wall, SCLN and the axillary lymph nodes in a locoregional order, and the bone, lung and liver in a systemic order. Of note is that distant recurrences commonly occurred at multiple sites in a simultaneous manner. CONCLUSION: Our findings revealed that the 5 year-recurrence rate was 17.7% and the risk of recurrence was maintained 5 years later after surgery, although the annual hazard rate had the highest peak at 2 years after breast cancer surgery. Because the stage, progesterone receptor status, and c-erbB2 expression are independent risk factors, early detection of breast cancer is required for reducing recurrence.

Malignant Peripheral Nerve Sheath Tumor of the Cauda Equina in Type I Neurofibromatosis: Case Report

We report a case of malignant peripheral nerve sheath tumor in the cauda equina, which was associated with neurofibromatosis type I. The tissue specimen acquired from the mass of cauda equina was transformed from benign to malignant form within 3 months. We report this case with review of the literatures.

Clear Cell Meningioma of Cauda Equina without Dural Attachment

We report a 17-year-old woman presented with a one-month history of lower back pain and radiating pain in the left leg. Examination revealed Lasegues sign in left leg with mild weakness of the plantar flexion of the left big toe. Magnetic resonance image revealed a well enhanced intradural lesion at the S1-2 level. Following a subtotal laminectomy of S1 and an intradural exposure, the roots of the cauda equina draped the tumor loosely without any attachment to the dura or cauda equina. The tumor was removed en bloc. The patient's recovery was uneventful. Histological examination confirmed a clear cell meningioma.

Usefulness of Angiographic Three-Dimensional Reconstruction of Spiral Computed Tomography Images for Postoperative Evaluation after Aneurysm Clipping with Titanium Clips

OBJECTIVE: The three-dimensional computed tomographic angiography(3D-CTA) images are not commonly used than the conventional digital subtraction angiography(DSA) as a postoperative examination to identify a remnant neck or whether the parent and branching arteries and the cerebral aneurysm are clipped together. We suggest that the neurosurgeons themselves can reconstruct 3D images using 3D reconstruction program in their personal computers and evaluate the aneurysm neck clipping state more precisely than DSA. METHODS: Both 3D-CTA and DSA images were obtained postoperatively on 40 patients with 45 cerebral aneurysms. 38 aneurysms were clipped by single clip, 6 by double clips, and 1 by triple clips. We compared 3D-CTA images, which are made by easy and noninvasive method of the new software to ascertain postoperatively the perfection of aneurysm neck clipping performed with titanium clips, with DSA. RESULT: Out of the total 45 cerebral aneurysms clipped with titanium clips, 3D-CTA clearly showed the state of the clipped necks and the parent and branching arteries of 44 aneurysms in 39 cases. There were three cases in which the remnant necks were found in 3D-CTA, but two of them were not identified in DSA. There was one patient who had cerebral aneurysms requiring 3 clips, resulting in a poor view of the remnant necks since the clips covered the necks. CONCLUSION: In case using one or two titanium clips for the aneurysmal clipping, 3D-CTA may be a reliable alternative method to DSA in the postoperative evaluation to define the cerebral aneurysm neck and the surrounding vessels after clipping.

The Use of the Programmable Valve Shunt System in the Management of Patients with Hydrocephalus

OBJECTIVE: The goal of this study was to clarify the value of the programmable valve shunt system to readjust the pressure noninvasively for the adequate cerebrospinal fluid(CSF) drainage. METHODS: The authors analyzed a single-center retrospective study of 54 patients suffering from hydrocephalus of various causes, as aneurysm(21 patients), trauma(13 patients), normal-pressure hydrocephalus(NPH, 7 patients) and so on. In 51 cases a programmable valve was implanted at the first shunt implantation. In three cases the shunt was replaced to a programmable valve system. RESULTS: In 33 patients(61%) of cases valve pressure adjustment was required at least once(total number of readjustment 54, mean 1.7, maximum 5) for the reason of underdrainage(36) or overdrainge(18). The range of reprogrammed valve pressure was 10 to 90mmH2O(mean 11.1+/-15.9mmH2O), the radiological finding improved 48.6% of frontal horn index at the beginning of reprogramming to 41.3%, and the clinical symptom related with hydrocephalus improved in 29 patients(87.8%) of pressure adjustment. Shunt reprogramming was necessary in patients with congenital hydrocephalus(100%), aneurysm(55%), NPH(71%), trauma(50%); the programmable valve proved particularly beneficial for overdrainge as subdural hygroma. CONCLUSION: The programmable valve was useful for the correction of overdrainge or underdrainage by the easy control of valve pressure without any invasive procedure.

Takayasu's Arteritis Presented with Subarachnoid Hemorrhage: Report of Two Cases

Takayasu's arteritis is a chronic inflammatory disease that produces a narrowing of the aorta and its major branches. Fibrosis and thickening of the arterial wall often occur in later stages, resulting in a cerebrovascular accident. The authors report two young women patients who presented with subarachnoid hemorrhage (SAH) and occlusive cerebrovasular disease associated with Takayasu's arteritis. Both patients had sudden headache and hemiparesis. Physical examination showed weak radial pulse, carotid bruit, and asymmetrical blood pressure. Erythrocyte sedimentation rate (ESR) was elevated in both patients. SAH was confirmed by brain computerized tomography (CT) or lumbar puncture. Occlusive cerebrovascular disease was diagnosed by brain magnetic resonance imaging (MRI), brain magnetic resonance angiography (MRA), and cerebral angiography. The findings of aortography and cerebral angiography were compatible with Takayasu's arteritis, but intracranial aneurysm was not found in either patient.

Urinary N-acetyl--D-glucosaminidase and Malondialdehyde as a Markers of Renal Damage in Burned Patients

This study was aimed to evaluate renal dysfunction during three weeks after the burn injuries in 12 patients admitted to the Hallym University Hankang Medical Center with flame burn injuries (total body surface area, 20-40%). Parameters assessed included 24-hr urine volume, blood urea nitrogen, serum creatinine, creatinine clearance, total urinary protein, urinary microalbumin, 24-hr urinary N-acetyl--D-glucosaminidase (NAG) activity, and urinary malondialdehyde (MDA). Statistical analysis was performed using repeated measures ANOVA test. The 24-hr urine volume, creatinine clearance, and urinary protein significantly increased on day 3 post-burn and fell thereafter. The urine microalbumin excretion showed two peak levels on day 0 post-burn and day 3. The 24-hr urinary NAG activity significantly increased to its maximal level on day 7 post-burn and gradually fell thereafter. The urinary MDA progressively increased during 3 weeks after the burn injury. Despite recovery of general renal function through an intensive care of burn injury, renal tubular damage and lipid peroxidation of the renal tissue suggested to persist during three weeks after the burn. Therefore, a close monitoring and intensive management of renal dysfunction is necessary to prevent burn-induced acute renal failure as well as to lower mortality in patients with major burns.

The Effect of Albumin Therapy for Reperfusion Injury Following Transient Focal Cerebral Ischemia in Rats

OBJECTIVE: Albumin is a very useful drug for the improving of cerebral blood volume and the oncotic effect in cerebral ischemia or cerebral vasospasm. The purpose of this study was to examine the morphological and neurological effect of albumin therapy on reperfusion injury following transient focal cerebral ischemia. MATERIALS AND METHODS: 18 Male Sprague-Dawley rats weighing 270-320g were used. The ischemia model was produced by 2-hour period of transient middle cerebral artery occlusion with a poly-L-lysin coated intraluminal suture. The agent(20% human serum albumin[HSA]) or control solution(NaCl 0.9%) was administered intravenously at a dosage of 1% of body weight immediate after reperfusion following a 2-hour period occlusion. Neurological function was evaluated by the postural reflex and the forlimb placing test during occlusion(at 60 min) and daily for 3 days thereafter. The brain was perfusion-fixed, and infarct volumes and brain edema were measured. RESULTS: The HSA significantly improved the neurological score in treated group. The rats of albumin treatment group showed significantly reduced total infarct volume(by 34%) and brain edema(by 81%) compared with saline-treated rats. CONCLUSION: HSA showed a substantial effect on the transient focal cerebral ischemia and reperfusion injury model. These results may indicate its usefulness in treating reperfusion injury patients after thrombolysis treatment for the thrombo-embolic major cerebral artery occlusions.