A Case of Extramedullary Plasmacytoma in Both Maxillary Sinuses

Plasmacytoma is a rare hematolymphoid malignancy. The three types of plasmacytoma, according to clinical features and morphological characteristics, include solitary bone plasmacytoma, extramedullary plasmacytoma (EMP), and multiple myeloma (MM). Although EMP of the head and neck region accounts for approximately 3% of all plasma cell tumors, the involvement of both paranasal sinuses is extremely rare. Herein, we describe a rare case of EMP involving both maxillary sinuses in a 73-year-old male patient who had achieved complete remission from MM following chemotherapy 2 years ago. The EMP was treated successfully with radiotherapy.

Comparative Analysis of Automatic versus Fixed Positive Airway Pressure Therapy for Severe Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#The purposes of this study were to compare the purchase rate and adherence regarding the use of two machines, continuous positive airway pressure (CPAP) and automatic positive airway pressure (APAP), and to determine associated factors affecting the purchase rate and adherence of PAP in the treatment of severe obstructive sleep apnea (OSA).Subjects and Method From March 2016 to December 2017, 45 patients diagnosed with severe OSA by polysomnography were enrolled in this study. Patients were prescribed CPAP or APAP by one doctor and allowed to decide whether to purchase the machine after a one-month lease period, which was identified as the purchase rate. Adherence was identified as using the machine 4 hight on 70% of nights following the PAP therapy of three months. @*Results@#The adherence rate of CPAP (84%) was statistically and significantly higher than APAP (55%) (p=0.033). However, there was no significant difference in the adherence rate between CPAP (76%) and APAP (63%). The mean pressure and 95th percentile leak were 8.62 cm H2O and 12.97 L/min in the CPAP and 10.55 cm H2O and 20.36 L/min in the APAP, respectively. The mean pressure and 95th percentile leak were significantly lower in CPAP than in APAP (p=0.010 and p=0.014, respectively). @*Conclusion@#Although adherence was not significantly different, the purchase rate was significantly higher in the fixed CPAP than in APAP, which may have been influenced by high pressure and leak patients experienced when using the particular PAP machine.

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

Objective@#To determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy. @*Methods@#We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer. @*Results@#For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH2O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH2O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types. @*Conclusion@#Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

Application of Stem Cell-Derived Extracellular Vesicles in Allergic Airway Diseases

Mesenchymal stem cells (MSCs) have been reported to be promising candidates for the treatment of allergic airway diseases. However, MSCs themselves have several problems including immune rejection, risk of aneuploidy, difficulty of handling, and tumorigenicity. An increasing number of studies demonstrated that administration of conditioned media or extracellular vesicles (EVs) released by MSCs is as effective as the MSCs themselves in suppression of allergic airway inflammation. EVs can exert their effects by delivering their contents such as proteins, mRNAs, and microRNAs to recipient cells. Furthermore, the administration of MSCs-derived EVs may reduce potential safety risks associated with stem cell therapy, suggesting that MSCs-derived EVs may be a promising alternative to cell therapy for allergic airway diseases. This review examines the current understanding of the immunomodulatory properties of MSCs-derived EVs and its therapeutic implication for allergic airway diseases.

Obstructive Sleep Apnea and Testosterone Deficiency

Obstructive sleep apnea (OSA) is a common disorder characterized by intermittent hypoxia and sleep fragmentation. OSA in middle-aged men is often associated with decreased testosterone secretion, together with obesity and aging. Although OSA treatment does not reliably increase testosterone levels in most studies, OSA treatment with testosterone replacement therapy (TRT) may not only improve hypogonadism, but can also alleviate erectile/sexual dysfunction. However, because TRT may exacerbate OSA in some patients, patients should be asked about OSA symptoms before and after starting TRT. Furthermore, TRT should probably be avoided in patients with severe untreated OSA.

Comparative Analysis of Endonasal Lateral Osteotomy and Percutaneous Lateral Osteotomy in Patients with Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The purpose of this study was to compare the effectiveness of percutaneous and endonasal lateral osteotomy for the correction of deviated nose.SUBJECTS AND METHOD: Medical records of 60 patients who underwent rhinoplasty to correct deviated nose were reviewed retrospectively. Patients with unilateral osteotomy, revision rhinoplasty, spreader graft, or who had no preoperative or postoperative photos were excluded from the study. The patients were categorized into two groups, which either had C-shaped deviation or I-shaped deviation. Preoperative and postoperative deviation angles were measured and their differences were analyzed according to the approach methods.@*RESULTS@#In the percutaneous approach group, 26 patients had C-shaped deviation and 10 patients had I-shaped deviation, whereas in the endonasal approach group, 17 patients had C-shaped deviation and 7 patients had I-shaped deviation. In the percutaneous approach, the deviation angle was statistically improved in the C-shaped deviation, but in the endonasal approach, it was statistically improved in the C-shaped and I-shaped deviation after surgery. In the C-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 5.2°±3.6° and 7.9°±5.3°, respectively, which showed significant difference. However, in the I-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 2.9°±1.3° and 2.9°±1.0°, respectively, with no significant difference.@*CONCLUSION@#The improvement of deviation angle following osteotomy may be different according to the approach methods for deviated nose. Endonasal approach was more suitable than percutaneous approach in the correction of I-shaped deviated nose.

Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy

PURPOSE: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.

Comparative Analysis of Endonasal Lateral Osteotomy and Percutaneous Lateral Osteotomy in Patients with Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the effectiveness of percutaneous and endonasal lateral osteotomy for the correction of deviated nose. SUBJECTS AND METHOD: Medical records of 60 patients who underwent rhinoplasty to correct deviated nose were reviewed retrospectively. Patients with unilateral osteotomy, revision rhinoplasty, spreader graft, or who had no preoperative or postoperative photos were excluded from the study. The patients were categorized into two groups, which either had C-shaped deviation or I-shaped deviation. Preoperative and postoperative deviation angles were measured and their differences were analyzed according to the approach methods. RESULTS: In the percutaneous approach group, 26 patients had C-shaped deviation and 10 patients had I-shaped deviation, whereas in the endonasal approach group, 17 patients had C-shaped deviation and 7 patients had I-shaped deviation. In the percutaneous approach, the deviation angle was statistically improved in the C-shaped deviation, but in the endonasal approach, it was statistically improved in the C-shaped and I-shaped deviation after surgery. In the C-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 5.2°±3.6° and 7.9°±5.3°, respectively, which showed significant difference. However, in the I-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 2.9°±1.3° and 2.9°±1.0°, respectively, with no significant difference. CONCLUSION: The improvement of deviation angle following osteotomy may be different according to the approach methods for deviated nose. Endonasal approach was more suitable than percutaneous approach in the correction of I-shaped deviated nose.

Effectiveness of Polyvinyl Acetate Sheeted with Carboxymethyl Cellulose as a Packing Material after Septoplasty

BACKGROUND AND OBJECTIVES: Although polyvinyl acetate (Merocel®) has been widely used as a packing material after septoplasty, removable nasal packing can increase patient discomfort, local pain, and pressure. Furthermore, the removal of nasal packing has been described as the most uncomfortable and distressing feature associated with septoplasty. The purpose of this study was to investigate the efficacy of polyvinyl acetate with carboxymethyl cellulose sheet (Rhinocel®) nasal packing on patient subjective symptoms, degree of bleeding, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHOD: Forty patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with Rhinocel® and the other one with Merocel®. Patient subjective symptoms while the packing was in situ, hemostatic properties, pain on removal, degree of bleeding on removal, duration of hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Although the two types of packing materials were equally effective in controlling postoperative bleeding after septoplasty, Rhinocel® was significantly more comfortable while in situ and less painful on removal than Merocel®, which was associated with significantly more bleeding on removal and so more time was needed to control hemorrhage. There was no significant difference in postoperative wound healing or pack cost. CONCLUSIONS: The use of Rhinocel® after septoplasty has less discomfort, greater patient satisfaction, and less bleeding on removal with no adverse reactions compared to Merocel® packing. Therefore, Rhinocel® may be a useful packing material after septoplasty.

Samter's Triad: State of the Art

Samter's triad (ST) is a well-known disease characterized by the triad of bronchial asthma, nasal polyps, and aspirin intolerance. Over the past few years, a rapid development in the knowledge of the pathogenesis and clinical characteristics of ST has happened. The aim of this paper is to review the recent investigations on the pathophysiological mechanisms and genetic background, diagnosis, and different therapeutic options of ST to advance our understanding of the mechanism and the therapeutic control of ST. As concern for ST increase, more application of aspirin desensitization will be required to manage this disease successfully. There is also a need for continued research efforts in pathophysiology, treatment, and possible prevention.

Effect of Doctor and Device Manager on Adherence with Positive Airway Pressure Therapy in Obstructive Sleep Apnea Patients

BACKGROUND AND OBJECTIVES: Although many studies have assessed factors related to adherence of PAP therapy, there were no studies about factors related to doctors or device managers. The purpose of this study was to investigate the relationship between PAP therapy adherence and doctor or device manager. SUBJECTS AND METHODS: Between February 2013 and June 2015, 163 patients newly diagnosed with moderate to severe OSA in one of five hospitals were enrolled in this study. All patients received 4 weeks of PAP treatment with intervention consisting of mechanical support and motivation by doctor and device manager. Data from the PAP device were obtained following a minimum of an initial 30 days, with adherence defined as >4 h/night on 70% of nights. RESULTS: After 30 days, total adherence rate to PAP therapy was 35.6% (n=58). The adherence rate of device manager ① was 26.3% (31/118), and that of device manager ② was 60% (27/45), and there was statistically significant difference between the two device managers. Furthermore, there were statistically significant differences in the adherence to PAP therapy ranging from 85.6% to 0.0% according to doctor. CONCLUSION: Our study demonstrates that the device manager and doctor may be important factors for good adherence to PAP therapy in patients with OSA.

Intraabdominal Cryptococcal Lymphadenitis in a Patient with Systemic Lupus Erythematosus

Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.

Clinical Significance of Autoantibodies to Glucose-6-Phosphate Isomerase in Synovial Fluid of Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Autoantibody against glucose-6-phosphate isomerase (GPI) has been shown to be present in both the serum and synovial fluid (SF) of patients with rheumatoid arthritis (RA). The purpose of this study was to evaluate whether GPI serves as a specific autoantigen in the SF of patients with RA and to investigate the relationship of anti-GPI antibody with clinical parameters of RA. METHODS: SF was collected from 34 patients with RA and 34 patients with osteoarthritis (OA). The samples were tested by enzyme-linked immunosorbent assay (ELISA) using human recombinant GPI as antigen. Patients with RA were classified according to rheumatoid factor (RF) positivity, the presence of RA shared epitope, the presence of extraarticular manifestations, and evidence of bony erosive changes. RESUTLS: SF levels of anti-GPI antibody were higher in patients with RA than in patients with OA (631.12+/-534.02 AU versus 112.38+/-90.45 AU, p<0.001). In RA, there was no significant difference in SF anti-GPI antibody levels according to RF positivity, the presence of extraarticular manifestations, and evidence of bony erosive changes. CONCLUSION: Autoantibodies to GPI in SF have more related with patients with RA compared with those with OA. In patients with RA, autoantibodies to GPI in SF are not associated with the poor prognostic factors and disease activity of RA.

Elevated Serum Levels of Macrophage Migration Inhibitory Factor (MIF) in Patients with Behcet's Disease / 대한류마티스학회지

OBJECTIVE: Macrophage migration inhibitory factor (MIF) has emerged recently as an important regulator of inflammatory and immune responses. This work was undertaken to evaluate serum levels of MIF and in vitro MIF production by whole blood cells in patients with Behcet's disease and investigate the relationship between serum levels of MIF and clinical manifestations. METHODS: Sixty-five patients with Behcet's disease and forty-eight healthy controls were studied to evaluate serum levels of MIF. Six patients with Behcet's disease and Five healthy controls were studied for evaluating the production of MIF by whole blood cells. Serum and culture supernatant levels of MIF were measured by enzyme-linked immunosorbent assay (ELISA). The production of MIF by whole blood cells was investigated by culturing peripheral blood cells in the absence or presence of Concanavalin A (Con A). RESULTS: Serum levels of MIF were higher in patients with Behcet's disease than in healthy controls. Serum levels of MIF were changed in each patient with Behcet's disease according to clinical disease activity (higher at active state). The MIF production by Con A-stimulated peripheral blood cell culture was higher in patients with Behcet's disease than in healthy controls. CONCLUSION: Circulating levels of MIF are higher in patients with Behcet's disease than in healthy controls and the levels of MIF may be associated with clinical disease activity. MIF may play an important role as a mediator of inflammation in Behcet's disease and provide opportunity for the development of anti-MIF strategy for the treatment of patients with Behcet's disease.

A Case of Azathioprine Induced Recurrent Acute Pancreatitis in a Patient with Behcet's Disease / 대한류마티스학회지

Acute pancreatitis is a serious disease with a fatality rate of up to 15%. Drugs are considered a rare cause of acute pancreatitis and azathioprine has been linked to subsequent acute pancreatitis in several case reports. We present a 48-year-old female who developed abdominal pain and elevation of serum amylase and lipase levels following azathioprine treatment for Behcet's disease. Abdominal CT scan reveals diffuse enlarged pancreas and large amount of fluid collection at peritoneal cavity. She was recovered with conventional therapy for acute pancreatitis and withdrawal of azathioprine. When the patient erroneously took the drug once again, acute pancreatitis was more rapidly developed than initial attack.

Efficacy and Tolerability of Mycophenolate Mofetil in Patients with Lupus Nephritis / 대한류마티스학회지

OBJECTIVE: To determine the therapeutic effect of mycophenolate mofetil (MMF) and the adverse effects associated with MMF in patients with lupus nephritis. METHODS: We studied 51 patients with lupus nephritis, who had received MMF for more than 3 months. The efficacy was assessed as renal profiles, SLE disease activity index (SLEDAI), serum cytokine levels and oral corticosteroid dose. The adverse effects were evaluated by medical records and interview of each patient. Serum cytokine levels of IL-10, IFN-alpha and IFN-gamma were determined by sandwich ELISA at starting MMF and at 12 months after MMF therapy. RESULTS: MMF treatment resulted in complete remission 52.9%, partial remission 25.5% and treatment failure 21.6%. There was no difference of MMF efficacy between WHO class IV and V in 32 patients with biopsy-proven nephritis. The renal profiles and parameters for disease activity were improved, as assessed by increased serum albumin and C3 level, decreased proteinuria, cyturia, ESR, SLEDAI and oral corticosteroid doses. Serum IL-10 decreased after MMF therapy in class IV group, but not in class V group. Serum IFN-alpha, IFN-gamma level and IFN-gamma/IL-10 ratio also tended to decrease after MMF therapy. GI troubles including dyspepsia, nausea, vomiting and diarrhea were the most common adverse effects of MMF as 54.9%, followed by hair loss, leukopenia, anemia, infection, but there was no serious adverse effect. CONCLUSION: MMF is an effective and well tolerable immunosuppressant for both class IV and V lupus nephritis, even not responding or intolerable to conventional immunosuppressive therapy.

Two Cases of Tunneled Supraclavicular Island Flap for Head and Neck Reconstruction / 대한이비인후과학회지

Reconstruction in the head and neck region uses a wide range of surgical flaps for defect closure. The methods range from local, mostly myocutaneous flaps, and skin grafts to free microsurgical flaps. Reconstructive surgery must conserve the appearance and mimic the original function. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. To achieve these goals, a thin reliable flap that is close to the face and neck region with a good match of the skin texture and a smooth, hairless skin surface is needed. So we used a flap from the shoulder region which provides an optimum skin texture to match the neck and face. This supraclavicular flap is a fasciocutaneous island flap, which has a vascular pedicle extending from the transverse cervical artery with two accompanying veins. Moreover, the tunneling method improves the donor site by reducing scarring. We hereby introduce the anatomic characteristics and effectiveness of this method.

A Case of Angiofibroma Arising in Parapharyngeal Space / 대한이비인후과학회지

Angiofibromas are rare histologically benign tumors that predominantly affect adolescent males and account for approximately 0.5% of all neoplasms of the head and neck. Although angiofibromas are histologically benign, but locally invasive. These tumors are highly vascular and associated with extension to the nose, paranasal sinus, pterygomaxillary fossa, infratemporal fossa, intracranium, and neck. The morbidity and mortality associated with these tumors are related to its prominent vascularity and its propensity for aggressive local growth. Pre-operative embolization is useful for reducing intraoperative blood loss and the risk of incomplete excision of the tumor. These tumors virtually arise from the nasopharynx in the region of the sphenopalatine foramen and pterygopalatine fossa. We present a unique case of an angiofibroma limited to the left parapharyngeal space, without involvement of the sphenopalatine foramen or nasopharynx. We treated this case with transparotid-cervical approach after pre-operative embolization.

Impaired Osteophyte formation in Patients with Type II Diabetes Mellitus and Knee Osteoarthritis / 대한류마티스학회지

OBJECTIVE: Insulin has been known as a potent growth factor for connective tissues including cartilage and bone.The pathogenesis of type 2 diabetes mellitus is the insulin resistance due to insulin receptor or postreceptor abnormalities.In the present study,we investigate whether radiographic features of knee osteoarthritis in patients with type 2 DM differ from those in nondiabetogenic controls with knee osteoarthritis. METHODS: Radiographs (knee)from 59 female patients with diabetes and knee osteoarthritis were compared with those from 74 female controls who were similar with respect to age,weight,and duration of OA symptoms.Based on the Kellgren and Lawrence criteria,an overall OA severity grade for the index knee was assigned and was rated for the severity of subchondral sclerosis,osteophytes, geodes and joint space narrowing.Patients with inflammatory arthritis such as RA,severe peripheral neuropathy,or diabetic nephropathy were excluded. RESULTS: Although the 2 groups were similar with respect to the severity of joint space narrowing,geode formation,and subchondral sclerosis,osteophytes formation was less common in patients with type 2 diabetes (P=0.041)than controls.In the patients with symptomatic knee OA at least for 11 years,marked osteophyte formation was noted only in 7 of the 17 with DM (41%),but in 15 of the 27 controls (55%). CONCLUSION: Our results suggest that diminished availability of insulin at the cellular level or diabetic microvascular disease may attenuate the chondro- and osteogenesis required for osteophyte formation in the joint of patients with OA.The clinical significance of osteophyte and the pathologic mechanisms of diminished osteophyte formation in patients of knee osteoarthritis with type 2 diabetes is to be determined.

Symptomatic Sacroiliitis in Female Systemic Lupus Erythematosus / 영남의대학술지

We report a case of 17-year-old female with juvenile onset systemic lupus erythematosus Who developed symptomatic unilateral sacroiliitis. She had neither HLA-DR3 nir B27 antigens. Though sacroiliitis have been reported in mail SLE patient. it has been rarely reported in female patients. The rare coexistence of SLE and sacroiliitis. described in this case. may not be determined soley by genetic factors; sacroiliitis may be just an infrequent manifestation of SLE.