Forensic Microbiological Analysis for Vaginal Fluid Identification Using Multiplex Real-Time PCR System / 대한법의학회지

Numerous methods for human body fluid identification using microbiological markers specific to different human body parts are well-established in forensic science. However, method for vaginal fluid screening have not been standardized yet. Therefore, in this study, a real-time polymerase chain reaction based assay for vaginal fluid identification was devised using bacteria residing in human vagina. This method employed three markers, namely Lactobacillus iners, Lactobacillus crispatus, and Bacteroides fragilis. L. iners and L. crispatus were chosen due to their high abundance in the vagina, whereas B. fragilis resides in the rectum. To examine the suitability of the new method for forensic microbial applications, a study of the distribution of vaginal flora in 143 Korean women was performed, along with characterization of the specificity, and performance of the new assay. Additionally, a casework study based on 130, 21, 20 and 17 DNA samples collected from the vagina, anus, saliva, blood, respectively, was carried out. L. iners (80.4%) and L. crispatus (55.2%) were detected with high abundance in the vagina of Korean women. The specificity of these markers was verified using microbial DNA from 23 species. This method could detect at least 1,000 copies/µL of microorganisms for all markers, thereby highlighting its robust sensitivity for vaginal fluid identification. The casework study confirmed these findings, with 89.2% (116/130) detection of vaginal fluid-derived DNA samples, and no false positives identified from the other sources studied. In conclusion, the developed method is expected to be efficient for preliminary microbiological analysis of vaginal samples in forensics.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.

A Case of Lemierre Syndrome Following Oropharyngeal Infection / 대한이비인후과학회지

Lemierre syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of pathogens, mainly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. Before the advent of antibiotics, the disease used to be common, incurring a high mortality rate. The disease is less frequently seen nowadays, but it is still a life-threatening disease, requiring a high index of suspicion and prompt treatment. We report a case of Lemierre syndrome, which showed oropharyngeal infection, and internal jugular vein thrombosis.

Osteitis Fibrosa Cystica Mistaken for Malignant Disease

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

Recurrent Extranodal Marginal Zone B-Cell Lymphoma Presenting as a Huge Cheek Mass after Radiotherapy on Ocular Adnexal Lymphoma / 대한이비인후과학회지

Extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) is a low-grade B-cell lymphoma that presents with an indolent clinicopathologic nature. Although this tumor can occur in various sites, including the gastrointestinal, skin, salivary gland and ocular adnexa, radiation therapy shows high local control in that disease. We report a case of recurrent MALT lymphoma presenting a huge cheek mass after radiotherapy on ocular adnexal lymphomas. An 65-year-old man had a history of treatments on MALT lymphomas of ocular adnexa came again with a huge cheek mass, not recurred and not originated from salivary gland, skin, other related mucosa tissues. He got excisional biopsy and was confirmed immunohistochemically as MALT lymphoma. After diagnosis, he was sent urgently to a radiotherapist for further treatment. He responded well to added radiotherapy with 36 Gy dose and has remained well at 6 months after his initial presentation.

Schwannoma in Head and Neck: Preoperative Imaging Study and Intracapsular Enucleation for Functional Nerve Preservation

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.

Usefulness of Intraoperative Parathyroid Hormone Assay in Minimally Invasive Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Intraoperative parathyroid hormone (PTH) assay has been proposed as an effective tool in minimally invasive parathyroidectomy. We evaluated its usefulness during minimally invasive parathyroidectomy. SUBJECTS AND METHOD: Ten patients (female 6, male 4) of primary hyperparathyroidism (8 single diseases, 2 multiple diseases) were analyzed retrospectively. We used computed tomography (CT) and 99mTc-Sestamibi (MIBI) scan for localization of parathyroid lesions preoperatively, and frozen biopsy and PTH assay at 10 (T-10), 20 (T-20) minutes after excision intraoperatively. We also compared the diagnostic sensitivity of CT and MIBI scan and intraoperative PTH. RESULTS: All patients were treated successfully and in single disease group, diagnostic sensitivity of CT, MIBI scan were 75% and 87.5%, and that of T-10 was 75% and T-20 was 100%. In multiple disease group, diagnostic sensitivity of CT, MIBI scan were 75%, 87.5%, and that of PTH was 80%. CONCLUSION: Intraoperative PTH assay improves cure rate in minimally invasive parathyroidectomy. It allowed intraoperative recognition of missed parathyroid lesions by preoperative imaging study.

Correlation of Glucose Transporter-1 Expression With Uptake of 18F-Fluorodeoxyglucose Positron Emission Tomography in Thyroid Papillary Carcinoma / 대한이비인후과학회지

Backgroud and Objectives: 18F-FDG Positron emission tomography (18F-FDG PET) is a noninvasive diagnostic tool for many kinds of human cancer, where glucose transporter-1 (Glut-1) acts as a main transporter in the uptake of 18F-FDG in cancer cells. The object of this study is to assess the expression of Glut-1 in human papillary carcinoma and the relationship between the expression and the uptake of 18F-FDG PET. SUBJECTS AND METHOD: We evaluated 30 patients diagnosed as papillary carcinoma. Tumor sizes were measured and Glut-1 expression rate (ER), expression intensity (EI) and total expression score (ES) were analyzed. 18F-FDG PET was performed in 19 patients and standardized uptake value (SUV) was measured in each case. The correlations between ER and SUV, ES and SUV, tumor sizes and SUV, ER and tumor sizes were analyzed statistically. RESULTS: 96.7% (29/30) of tumors were Glut-1 positive, the mean ER was 67.42+/-22.89% and the mean ES 131.8+/-71. Tumor cells showed higher expression of Glut-1 than normal thyroid tissue. 18F-FDG uptake was positive in 81% (17/21) of solitary thyroid papillary carcinoma and negative in 19% (4/21). The average SUV of the PET positive group was 6.75+/-4.8, ER 71.25 +/-20.6% and ES 134.68+/-51.4. The average size of PET positive tumors was 3.37+/-2.94 cm2 and that of negative tumors was 0.43+/-0.45 cm2. Both ER and ES of Glut-1 were correlated with SUV significantly. The size and SUV were also correlated significantly. But the size and ER were not correlated significantly. CONCLUSION: Thyroid papillary carcinoma has high ER of Glut-1 and there is a positive correlation between Glut-1 expression and the uptake of 18F-FDG PET. The size of tumor can also affect the 18F-FDG uptake. But there is no correlation between the size and Glut-1 expression and further studies are needed to find the mechanisms and to decide the cut-off value.

A Case of the EXIT (Ex Utero Intrapartum Treatment) Procedure in Congenital Fetal Cervical Immature Teratoma / 대한이비인후과학회지

The exutero intrapartum treatment (EXIT) is an uncommon procedure indicated for fetal lesions with the potential to cause lifethreatening airway obstruction immediately after child delivery. Maintenance of the maternal-fetal circulation under the general anesthesia can allow time for the fetal airway to be secured before delivery. Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size can potentiate life-threatening upper airway obstruction. We have recently experienced a case of the large fetal cervical teratoma diagnosed prenatally on ultrasonography and treated surgically using the EXIT procedure.

Steatocystoma Simplex of the Anterior Neck / 대한이비인후과학회지

As a benign adnexal tumor, steatocystoma usually occurs as an autosomal dominant condition known as steatocystoma multiplex. Steatocystoma simplex, the noninherited solitary counterpart of steatocystoma multiplex,was first described by Brownstein in 1982, and is exceedingly rare. We report a case of steatocystoma simplex in a 27-years-old female, who presented with an asymptomatic soft, oval shaped mass on the lower anterior neck. The lesion was completely excised and confirmed as steatocystoma simplex on histopathological examination.

Evaluation of Internal Laryngeal Muscles Related to Phonation and the Compensatory Mechanism in Patients with Unilateral Vocal Cord Paralysis Using (18)F-Fluorodeoxyglucose-Positron Emission Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Several studies have reported that (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) imaging is physiologically increased at the intact vocal cord in patients with unilateral vocal cord paralysis, which is explained by a compensatory mechanism of the intact vocal cord. We aimed to evaluate internal laryngeal muscles related to phonation and the compensatory mechanism in patients with unilateral vocal cord paralysis. SUBJECTS AND METHOD : We performed (18)FDG-PET imaging and neck computed tomography (CT) scan in the normal control group composed of 13 subjects and the paralyzed group composed of 11 patients with unilateral vocal cord paralysis. The two groups were divided into two groups, phonating and silent, before performing (18)FDG-PET. (18)FDG-PET and neck CT images by Syntegra. A specialist in nuclear medicine performed all the test measurements, the standardized uptake value (SUV) in the interarytenoid muscle (IA), both thyroarytenoid muscles (TA), and both lateral cricoarytenoid muscles (LCA). The mean SUVs were statistically analyzed. RESULTS : In the Normal-Phonating group, the mean SUV of IA was the highest, with 3.68+/-0.96 (Mean+/-SD), followed by that of LCA, with 2.34+/-0.67. However, when compared with the same muscles in the Phonating-Silent group, only the SUV of IA was significantly increased by phonation. In the Paralyzed-Silent group, the SUV of TA in the intact side was the highest, with 2.30+/-0.39. In the Paralyzed-Phonating group, the SUV of TA in the intact side, IA, and LCA in the intact side were 5.88+/-2.65, 3.92+/-1.65, and 3.87+/-1.37, respectively. When compared with the same muscles in the Phonating-Silent group, the SUVs of TA and IA were significantly increased. CONCLUSION : The muscle related to the compensatory mechanism in patients with unilateral vocal cord paralysis is thyroarytenoid muscle in the intact side. The interarytenoid muscle plays a major role in the mechanism of phonation in humans.

Two Cases of Tragal Cartilage Graft in Rhinoplasty

Ear cartilage is an important source of graft in rhinoplasty. The majority of ear cartilage grafts are harvested from the concha of the ear. However, in some restricted cases, the tragal cartilage can be a more favorable graft source than conchal cartilage. In this report, two cases of tragal cartilage graft rhinoplasty were selected. We used the tragal cartilage for batten graft in one case, and for the shield graft in the other case. Tragal cartilage harvesting technique was fast, simple, and did not require a special dressing. The functional and aesthetic results were relatively good. There was negligible scar formation in the donor site.

A Case of Invasive Fungal Sinusitis Accompanied with Inflammatory Pseudotumor in Skull Base / 대한이비인후과학회지

Skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, but atypical skull base osteomyelitis arising from the sphenoid or occipital bones without external otitis can occur much less frequently and initially may present headache as the only symptom. Inflammatory pseudotumor is an idiopathic condition characterized by the sclerosing inflammation, which mimicks a neoplastic process. Inflammatory pseudotumor involving skull base and cervical spine is distinctly rare and usually indistinguishable from aggressive neoplasms or infection at these area. We report a case which was confirmed histologcally as invasive fungal sinusitis accompanied with inflammatory pseudotumor: the treatment consisted of amphotericin B and systemic steroid therapy but ended in a failure.

Two Cases of Nasolacrimal Duct Cyst Developed in Neonate

Bilateral nasolacrimal duct cyst is an uncommon disease causing respiratory and feeding difficulty in neonates. It can either present pure intranasal cystic mass or be associated with dacryocystocele and/or dacryocystitis. Symptoms and signs of nasolacrimal duct cyst are different according to the patient's age and its bilaterality. Therefore, treatment should be individualized according to its presentation. The authors experienced one case of bilateral nasolacrimal duct cyst without dacryocystocele which caused respiratory difficulty and another case of nasolacrimal duct cyst associated with dacryocystocele. Both cases were treated by endoscopic marsupializaion of the cysts. We report these two cases with a brief review of the literature.

Etiology and Early Treatment Results of Acute Mesenteric Ischemia

PURPOSE: Acute abdominal pain can be the result of many different pathophysiological processes. Among the many possible causes, acute mesenteric ischemia is a life threatening condition if the diagnosis is delayed. Generally, the mortality rate for other disease has gradually decreased; however, the mortality rate for acute mesenteric ischemia has not changed significantly and it continues to be 75% to 80% for acute mesenteric arterial embolism or thrombosis and 44% for acute mesenteric venous thrombosis. The aim of this study was to conduct an analysis of the clinical characteristics and mortality of the patients with acute mesenteric ischemia according to the etiology. METHOD: From 1989 to 2004, 43 patients were treated for acute mesenteric ischemia. Their mean age was 59 years, ranging from 24 to 81, and the male to female gender ratio was 24:19. We retrospectively analyzed their initial symptoms, the age and gender distribution, the treatment modalities and the mortality rates. RESULT: The causes of acute mesenteric ischemia were arterial embolism in 27 cases, arterial thrombosis including arterial dissection in 7 cases and venous thrombosis in 9 cases. Almost all of the patients complained of acute abdominal pain and abdominal tenderness. The overall mortality rate was 30.2% and the rates were 37.0% for mesenteric artery embolism, 42.9% for mesenteric artery thrombosis and 0% for mesenteric venous thrombosis. CONCLUSION: In this study, the causes of acute mesenteric ischemia were mesenteric artery embolism and thrombosis, including dissection and mesenteric venous thrombosis. The factors influencing the mortality were the cause of the acute mesenteric ischemia, the extent of involvement of the mesenteric vessels and the extent of bowel necrosis. Thus the most important things for the treatment of acute mesenteric ischemia are early diagnosis and proper treatment.