Primary Hepatic Schwannoma / 대한소화기학회지

A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.

Microscopic polyangiitis with crescentic glomerulonephritis initially presenting as acute pancreatitis

No abstract available.

A Case of Solitary Relapsed Diffuse Large B-cell Lymphoma of the Gallbladder / 대한췌담도학회지

Secondary involvement of the gallbladder by systemic lymphoma is exceedingly rare and relapsed diffuse large B cell lymphoma of the gallbladder has not been reported. A 78-year-old man was admitted to the hospital due to epigastric pain and jaundice. His past medical history was remarkable for diagnosis with diffuse large B-cell lymphoma of the ileum 5 years ago. He underwent right hemicolectomy and three cycles of adjuvant chemotherapy and had complete remission. Abdominal computed tomography showed choledocholithiasis and focal thickening at fundus of the gallbladder. The patient underwent open cholecystectomy. Pathologic examination revealed diffuse large B-cell lymphoma. We report a case of solitary, relapsed diffuse large B-cell lymphoma of the gallbladder with literature review.

A case of peritoneal dialysis-associated peritonitis by Rothia mucilaginosa

Rothia muciliaginosa (R. mucilaginosa) is a facultative, Gram-positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract. There are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities, as well as meningitis, septicemia, and pneumonia associated with intravenous drug abuse. However, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Although R. mucilaginosa is generally susceptible to penicillin, ampicillin, cefotaxime, imipenem, rifampicin, and glycopeptides, there are no guidelines for the treatment of PD-associated peritonitis. Herein, we report a case of PD-associated peritonitis due to R. mucilaginosa that was resolved with intraperitoneal antibiotic treatment.

A Collision Tumor Comprising Early Gastric Adenocarcinoma and Diffuse Large B-cell Lymphoma after Endoscopic Gastric Submucosal Dissection

Concurrence of primary gastric adenocarcinoma and lymphoma have been described very rarely in the literature; its incidence is estimated at 0.08%. To our knowledge, there are no reports about a collision tumor comprising early gastric cancer and diffuse large B-cell lymphoma from the same lesion. The term "collision tumor" refers to the coexistence of two or more histologically distinct tumors within the same mass with no histologic admixture. A 76-year-old man complained of a 5-month-history of dyspepsia, and underwent esophagogastroduodenoscopy. Endoscopic findings showed a nodular, round, flat mass lesion in the upper body, therefore we performed endoscopic submucosal dissection (ESD). Pathologic findings revealed a well-differentiated adenocarcinoma accompanied by diffuse large B-cell lymphoma without evidence of Helicobacter pylori infection. Conventional CT and PET-CT scans revealed metastatic lymph nodes in the parotid gland, submandibular gland, maxillary gland and the inguinal regions. The pathogenesis of a collision tumor comprising two different cancers is not well understood. In addition, there are no established treatment guidelines in this series. In the current case, the patient underwent ESD for the removal of adenocarcinoma concomitantly with chemotherapy for the management of metastatic lymphoma.

A Case of Diabetic Ketoacidosis with Refractory Metabolic Acidosis Successfully Treated with Continuous Hemodiafiltration

Diabetic ketoacidosis (DKA) is a complex medical disorder characterized by abnormalities in electrolyte, acid-base, and volume status. Metabolic acidosis in mild and moderate DKA is corrected with insulin therapy. Bicarbonate therapy may be indicated in cases of severe metabolic acidosis, however the use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. Renal replacement therapy can be used for correction of systemic acidemia. Continuous renal replacement therapy (CRRT) is used in patients who are too hemodynamically unstable to tolerate conventional hemodialysis, but has also been used in treatment of patients with severe DKA. CRRT has never been used previously in DKA patients with refractory metabolic acidosis in Korea. Here, we describe the successful treatment of a DKA patient with refractory metabolic acidosis with CRRT.

Time Course of the Suppression Effect on Transient Evoked Otoacoustic Emissions by Prolonged Contralateral Acoustic Stimulation

BACKGROUND AND OBJECTIVES: Although the suppressive effect of the medial efferent acoustic reflex is well known, the time course of this effect over prolonged periods has yet to be fully evaluated. We assessed time-dependent change in the suppression of transient evoked otoacoustic emissions (TEOAEs) by the medial efferent acoustic reflex over a relatively long period. SUBJECTS AND METHODS: We measured TEOAEs in the right ear before contralateral acoustic stimulation (CAS), and then measured serial TEOAEs in the right ear at four intervals during a total of 16 minutes of continuous CAS, followed by three more recordings after termination of CAS. RESULTS: TEOAE amplitudes were reduced with CAS during a certain period (from the immediate period to 10 minutes depending on frequency) and subsequently recovered. TEOAE suppression values in the mean amplitudes for overall frequency were 0.76 dB at the initial recording, 0.35 dB at 5 minutes, 0.44 dB at 10 minutes, and 0.33 dB at 15 minutes during CAS. The initial suppression value was significantly larger than other suppression values of 5, 10, and 15 minutes (p<0.05). In recordings obtained after CAS, TEOAE amplitude exceeded pre-acoustic amplitudes at 1 kHz, 1.5 kHz, and 2 kHz. CONCLUSIONS: The present results show the existence of the medial efferent acoustic reflex and demonstrate the time course that TEOAE suppressions present initially after CAS, showing fatigue over time. Overshooting of TEOAE was observed in recordings at several frequencies after termination of CAS.

Time Course of the Suppression Effect on Transient Evoked Otoacoustic Emissions by Prolonged Contralateral Acoustic Stimulation

BACKGROUND AND OBJECTIVES: Although the suppressive effect of the medial efferent acoustic reflex is well known, the time course of this effect over prolonged periods has yet to be fully evaluated. We assessed time-dependent change in the suppression of transient evoked otoacoustic emissions (TEOAEs) by the medial efferent acoustic reflex over a relatively long period. SUBJECTS AND METHODS: We measured TEOAEs in the right ear before contralateral acoustic stimulation (CAS), and then measured serial TEOAEs in the right ear at four intervals during a total of 16 minutes of continuous CAS, followed by three more recordings after termination of CAS. RESULTS: TEOAE amplitudes were reduced with CAS during a certain period (from the immediate period to 10 minutes depending on frequency) and subsequently recovered. TEOAE suppression values in the mean amplitudes for overall frequency were 0.76 dB at the initial recording, 0.35 dB at 5 minutes, 0.44 dB at 10 minutes, and 0.33 dB at 15 minutes during CAS. The initial suppression value was significantly larger than other suppression values of 5, 10, and 15 minutes (p<0.05). In recordings obtained after CAS, TEOAE amplitude exceeded pre-acoustic amplitudes at 1 kHz, 1.5 kHz, and 2 kHz. CONCLUSIONS: The present results show the existence of the medial efferent acoustic reflex and demonstrate the time course that TEOAE suppressions present initially after CAS, showing fatigue over time. Overshooting of TEOAE was observed in recordings at several frequencies after termination of CAS.

Analysis of Correlation between Cognitive Function and Speech Recognition in Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Speech in the noise test has been known to reflect the distortion component of hearing impairment originated not only from the cochlea but also from the central auditory system. For communication with language, a proper cognitive function of the cerebral cortex is essential. In the present study, we aimed to evaluate the correlation between the cognitive function and the speech recognition ability against background noise. SUBJECTS AND METHOD: Thirty one listeners with sensorineural hearing loss in both ear participated in this study. We performed pure a tone audiometry, a speech recognition test with and without multitalker babble noise, a computerized cognitive function test and the Mini-Mental Status Examination-Korea. RESULTS: Speech recognition score in noise showed significant correlations with the results of both computerized cognitive function test and Mini-Mental Status Examination-Korea, whereas, the pure tone average and speech recognition score in the quiet background did not. CONCLUSION: These results support that speech recognition ability in background noise reflects the cognitive function.

Hearing Loss in Patients with Rheumatoid Arthritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In patients with rheumatoid arthritis (RA), sensorineural (SN), conductive, and mixed hearing loss (HL) have been reported in increased rates compared with persons without RA. The object of this study was to evaluate the prevalence and type of HL in patients with RA. We also examined the correlation between HL and the clinical data and determined which factors may be involved in the pathogenesis of RA-related HL. SUBJECTS AND METHOD: In this prospective controlled study, we compared 40 RA patients with 40 age and sex-matched controls. All patients underwent rheumatologic evaluation including ESR, CRP, rheumatoid factor, rheumatoid nodule, etc. Audiologic assessment consisting of pure tone, speech, impedence audiometry, and tone decay test was performed. Statistical analysis of the two groups was carried out. RESULTS: The prevalence of the SNHL (air conduction threshold of >30 dB at > or =1 frequency or >25 dB at > or =2 frequencies and both air and bone conduction thresholds within 10 dB of each other) was significantly higher in the RA group (42.5%), and the majority was bilateral and cochlear type. Air conduction threshold at 8,000 Hz differed significantly between the patients and the control group (p< 0.05). Speech and impedence audiometry did not differ in both groups. The presence of SNHL in patients with RA was related to ESR, CRP, patients' age, and medication such as prednisolone. CONCLUSION: SNHL of the cochlear type is increased in patients with RA especially at 8,000 Hz.

Effects of Various Background Noises on Speech Intelligibility of Normal Hearing Subjects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In auditory tests, several kinds of background noises have been used ; multitalker babble noise, speech noise and white noise, etc. The aim of the present study was to evaluate the effects of different types of background noises on speech intelligibility. SUBJECTS AND METHOD: Sixty volunteers having pure-tone thresholds less than 25 dB HL participated in this study. Their ages ranged from teens to sixties with ten subjects in each age group (mean age=40+/-15.4 years, m=25, f= 35) We used three types of background noises used in this study ; multitalker babble noise using the voices of Korean speakers, speech noise using English sentences and white noise. Fifty percent recognition of signal to noise ratios (SNRs) and word recognition scores (WRSs) at -10, -5, 0 dB SNR conditions were measured at 70 dB HL of noise intensity. RESULTS: Fifty percent recognition of SNRs on multitalker babble, speech and white noise were -12.4+/-1.4 dB, -13.7+/-1.0 dB and -15.8 +/-1.0 dB, respectively and they were significantly different each other (p< 0.05). Multitalker babble noise generated the lowest WRSs followed by speech noise and then white noise (p< 0.05). CONCLUSION: These results support that multitalker babble noise using the voices of Korean speakers influence on normal listener's speech intelligibility more than speech noise from English sentences or white noise

Comparison of 50% Recognition Signal-to-Noise Ratio Using a Multi-Talker Babble Noise in Normal-Hearing and Hearing-Impaired Individuals / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most common complaint of individuals with hearing impairment is the difficulty in understanding speech against background noise. In our previous study, we carried out a speech-in-noise test using multi-talker babble noise and spondee words. In the present study, we compared 50%-signal to noise ratios (SNRs) of hearing-impairment group with that of normal-hearing group, and analyze the effects of age and noise intensity affecting the results. SUBJECTS AND METHOD: Thirty listeners (of which each 10 listeners are in their forties, fifties, and sixties) with normal hearing and thirty listeners (each ten listeners in their forties, fifties, and sixties) with hearing impairment participated. Spondee words and multi-talker babble noise made from recording the voices of 10 males and 10 females were presented by a loudspeaker at a distance of one meter in front of the subject. Fifty percent-SNRs were measured at 50 dB HL, 60 dB HL, 70 dB HL, and 80 dB HL of noise intensity. RESULTS: The mean 50% SNR for normal-hearing listeners in the forties, fifties and sixties of age were -13.4+/-2.1 dB, -11.5+/-2.3 dB, and -12.6+/-2.0 dB, respectively. The mean 50% SNR for hearing-impairment listeners in the forties, fifties and sixties of age were -11.2+/-3.4 dB, -9.5+/-3.0 dB, -8.7+/-2.7 dB, respectively. Hearing-impairment group showed significantly worse results than the normal- hearing group in all ages. CONCLUSION: These results support that our word-in-noise test using multi-talker babble noise is useful in measuring audibility against background noise for individuals with hearing-impairment.

A comparative study between degree of conversion and flexural strength of composite resins / 대한치과보철학회지

Statement of problem. Although many studies have been carried out to investigate the correlation between the degree of conversion and the flexural strength of composite resins, there is minimal information in the literature attempting to compare degree of conversion, flexural strength and their correlation between restorative composite resins and flowable composite resins. Purpose. The purposes of this study were to measure the degree of conversion and flexural strength of composite resins with different rheological behavior and to correlate the two properties. Materials and methods. Four restorative (Vit-l-escence, Z-250, Tetric ceram, Esthet-X) and four flowable (Aeliteflo, Admiraflow, Permaflo, Revolution) light-curing composite resins were investigated. The degree of conversion(DC) was analyzed with Fourier transfer infra-red spectroscopy(FTIR) spectrum by a potassium bromide(KBr) pellet transmission method. The spectrum of the unpolymerized specimen had been measured before the specimen was irradiated for 60s with a visible light curing unit. The polymerized specimen was scanned for its FTIR spectrum. The flexural strength(FS) was measured with 3-point bending test according to ISO 4049 after storage in water at 37 degree C for 24 hours. The data were statistically analyzed by an independent sample t-test and one-way ANOVA at the significance level of 0.05. The dependence of flexural strength on the degree of conversion was also analyzed by regression analysis. Results. Mean DC and FS values ranged from 43% to 61% and from 84.7MPa to 156.7MPa respectively. DC values of the flowable composite resins were significantly higher than those of restorative composite resins (P < 0.05). The FS values of restorative composite resins were greater than those of flowable composite resins. No statistically significant correlation was observed between the DC and the FS tested in any of the composites. The dependence of FS on DC in restorative or flowable composite resins was not significant. Conclusion. It can be concluded that radical polymerization of the organic matrix is not a major factor in determining flexural strength of the commercially available composite resins.

A Case Report of a Bronchogenic Cyst Misconceived to Lung Cancer / 결핵

Bronchogenic cysts are generally presented as a well defined mass that have thin and smooth wall in the intrapulmonary or mediastinal area by simple chest radiographs. We present the case of a 20-year-old man with a ill-defined left upper lobe mass, found by chest radiographs. At the preoperative examinations, chest computed tomography showed ill-defined mass with Hounsfield Number 26, and nonspecific findings were shown by the bronchoscopy and percutaneous needle aspiration. The patient was undertaken the left upper lobectomy. The surgical specimen contained a ill-defined mass, measuring 2x3 cm. On the section of the mass, a cyst containing dark brown thick materials was noted. The cyst was unilocular, and the wall showed a trabeculation. Microscopically, the cystic mass was lined with ciliated pseudostratified columnar epitheliums and surrounded by smooth muscle and cartilage.

The Clinical Spectrum of Gastroesophagel Reflux Disease in Korea / 대한소화관운동학회지

BACKGROUND/AIM: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. METHODS: Patients who were diagnosed by an endoscopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. RESULTS: Seventy one patients were included. Heartburn was occurring in 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. CONCLUSIONS: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux. GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain.

A case of achalasia without dilatation of the esophageal body / 대한소화관운동학회지

Achalasia is a motility disorder of the esophagus consisting of abnormal relaxation of the lower esophageal sphincter and aperistalsis of the esophageal body. Esophageal dilatation and bird beak appearance are characteristic radiologic findings of achalasia, but achalasia patients do not always show typical findings on esophagography. We recently experienced a 38-year-old female patient who complained of chest pain and dysphagia. She showed no dilatation of the esophagus with delayed emptying of the contrast media in esophagography, but achalasia was diagnosed by typical manometric findings. The patient's symptoms improved after a balloon dilatation. Therefore, esophageal manometry should always be performed when the patient's history suggests the presence of achalasia without typical radiologic findings. We report this case with a review of the literature.

Diagnosis of Fatty Liver Complicated by Simple Obesity in Children: Serum ALT and Its Correlation with Abdominal CT and Liver Biopsy / 대한소아소화기영양학회지

PURPOSE: The purpose of our study is to provide useful information for diagnostic methods of fatty liver by childhood simple obesity and to provide correlation between serum alanine aminotransferase (ALT) for screening test and abdominal computerized tomography (CT) and liver biopsy for confirmative diagnostic methods of fatty liver. METHODS: Among 78 obese childrens who visited our hospital, CT was carried out in 26 childrens. Of these, liver biopsy was carried out in 15 childrens who had high obesity index or severe elevated ALT. Based on the level of serum ALT, 26 cases were classified into 3 groups, and compared with physical measurements and degree of fatty infiltration on CT and liver biopsy. RESULTS: 1) Correlation between ALT and physical measurements: Of 26 obese children, ALT was abnormally elevated (>30 IU/L) in 17 cases (67.4%) but there was no significant correlation between ALT and physical measurements (p>0.05). 2) Correlation between degree of fatty infiltration on CT and ALT: Of 26 cases, 13 cases (50%) revealed fatty liver on CT. The degree of fatty liver on CT had significant correlation with elevation of ALT (p0.05), but significant correlation with ALT (p<0.05). 4) Correlation between CT and liver biopsy finding: Both CT and liver biopsy were performed in 15 cases of which 6 cases revealed normal finding on CT and 9 cases manifested fatty liver. There was significant correlation between CT and liver biopsy findings (r=0.6094). CONCLUSION: The results of our study suggest that abdominal CT and liver biopsy are useful and accurate methods of estimating fatty liver in the childhood obesity. But biochemical abnormalities of routine liver function tests dot not correlate well with severity of the fatty liver and liver injury.

A Case of Recovery from Suspended Animation caused by Puffer fish Poisoning: a case report

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.

Changes in Antibody Titers of Measles, Mumps, Rubella, and Hepatitis B Virus AftEr Bone Marrow Transplantation in Korea: A Preliminary Report / 감염

BACKGROUND: Bone marrow transplantation (BMT) has become a significant treatment modality for hematopoietic and solid organ malignancy. Recipients of BMTs lose immunity to measles-mumps-rubella (MMR) and hepatitis B infections which are preventable with vaccination. There is no consensus regarding a vaccination schedule after BMT and time of vaccination is variable according to each institution. We analyzed sequential changes in antibody titers of MMR and hepatitis B during the first year after BMT in an attempt to identify the time, dose, and needs for revaccination. METHODS: Total 20 patients with hematologic malignancies were studied. Serum levels of IgG antibodies of MMR and hepatitis B virus (HBV) were determined every three months post-BMT by enzyme immunoassay (EIA), chemical luminescence immunoassay (CLIA) and immunofluorescence assay (IFA). RESULTS: IgG antibody levels of measles, rubella, HBV were 1:746, 80 85 IU/mL, 214 343 IU/L before BMT, declined to 1:633, 18 11 IU/mL, 4 6 IU/L one year after BMT, respectively. All the antibody levels were still above cut-off value for positive immunity. Mumps antibody titers were 1:62 before BMT, declined to 1:25 significantly from 6 months after BMT, but the antibody level was still above cut-off value. CONCLUSION: Antibody titers of MMR and hepatitis B decline during the first year after BMT, but the levels are still above cut-off value. Thus, the timing of revaccination should be after the first year post-transplantation. Long-term studies are needed to determine the optimal time for revaccination.

Identification of Mycobacterium tuberculosis Complex Using a Gene Probe method / 대한임상병리학회지

BACKGROUND: Rapid and accurate identification of Mycobacterium tuberculosis complex is important in the diagnosis, treatment, and assessment of prognosis of tuberculosis. But, the conventional identification procedures such as niacin test usually requires considerable time. In this study, we compared the diagnostic value of a gene probe method with that of the niacin test for the differentiation of M. tuberculosis complex from mycobacteria other than tuberculosis (MOTT). METHODS: Commercially available gene probe kit(AccuProbeTM, Gen-Probe, Inc. , San Diego, Calif.) and Niacin test strip were used to identify 78 strains of mycobacteria isolated from patients at Asan Medical Center. One ATCC strain (M. tuberculosis complex) and one MOTT strain were used as controls. Polymerase chain reaction(PCR) was used when the above two tests yielded discordant results. RESULTS: Fifty isolates were identified as M. tuberculosis complex by both gene probe method and niacin test. Likewise 25 isolates were identified as MOTT by the both methods. For the remaining 5 isolates, the results of the two tests differed from each other: M. tuberculosis complex by gene probe and MOTT by niacin test. By PCR, however. these strains were identified as M. tuberculosis. The time required for identification was 1 to 2 hours by gene probe method and 1 to 3 weeks by niacin test. CONCLUSION: Gene probe is simple, rapid and reliable and is a very practical diagnostic tool that can be used in any clinical laboratory.