Test-Retest Reliability of Word Recognition Score Using Korean Standard Monosyllabic Word Lists for Adults as a Function of the Number of Test Words

BACKGROUND AND OBJECTIVES: The purpose was to establish the test-retest reliability of word recognition score (WRS) using Korean standard monosyllabic word lists for adults (KS-MWL-A) recently developed based on the international standard for speech audiometry (ISO 8253-3:2012). SUBJECTS AND METHODS: Subjects consisted of 159 adults aged to 18 to 25 years with normal hearing sensitivity. WRSs were obtained in 2 dB steps from the level of speech recognition thresholds to the level of 86% correct responses or greater. After one or two weeks, retest was performed. Correlation, confidence interval (CI) and prediction interval (PI) were calculated for the reliability. RESULTS: Correlation coefficients were 0.88 for 50 test words, 0.76 for 25 and 0.61 for 10 words. Results also showed that 95% CIs and PIs were narrower for 25 and 50 test words than those for 10 test words. CONCLUSIONS: Korean WRS using the KS-MWL-A has high reliability for 25 and 50 test words, but relatively low for 10 words. It suggested that 95% CIs for each test words would be criteria for significant differences in WRS for groups and 95% PIs at each score of WRS could be utilized for a considerable difference for each individual at retest.

A Case of Duodenal Ulcer Perforation Combined with Scrub Typhus / 대한내과학회지

Scrub typhus is an acute febrile illness that results from the destruction of endothelial cells by Orientia tsutsugamushi and subsequent systemic vasculitis. It manifests as fever, headache, myalgia, eschar formation, and lymphadenopathy. Some authors have reported that such vasculitis involves the gastrointestinal tract and that hyperemia, erosion, ulceration, and active bleeding of the gastric mucosa subsequently develop. However, no case of ulcer perforation in a patient with scrub typhus has been reported to date. Here, we report the case of a perforated duodenal ulcer in a 70-year-old female patient with scrub typhus.

A Case of Gastric and Colonic Submucosal Tumors after the Removal of 51 Anisakis Larvae / 대한내과학회지

A 60-year-old man visited the outpatient clinic complaining of spasmodic abdominal pain. The symptoms had started 4 days previously, within 1 hour of eating sliced raw flatfish (sashimi) and a piece of flatfish gut. Gastroscopy revealed generalized mucosal edema, erythema, multiple erosions, and numerous worms penetrating the gastric mucosa at the greater and lesser curvatures of the middle and lower corpora. Fifty-one worms, 0.5-3 cm in length, were successfully removed with biopsy forceps. Three weeks later, a normal mucosa-covered, 3.5-cm round submucosal tumor (SMT) was found on the greater curvature of the lower corpus and four yellowish, 1-cm SMTs were found on the hepatic flexure of the colon. Histopathological examination revealed marked eosinophilic infiltration in the gastric and colonic mucosa and an eosinophilic abscess in the submucosa. Here, we report a case of eosinophilic granuloma manifesting as SMTs in the stomach and colon after the endoscopic removal of a large number of anisakids.

A Case of Gastrointestinal Bleeding after a Snake Bite / 대한내과학회지

The clinical presentation of snake bites varies greatly. Symptoms range from only bite marks to muscle spasms, paralysis, altered mental status, and muscle weakness. In severe cases, symptoms may include life threatening coagulopathy or gastrointestinal bleeding owing to increased vascular permeability. In this report, the patient presented with massive gastrointestinal bleeding after a snake bite and recovered with conservative treatment.

Simultaneous Melanosis Duodeni and Melanosis Ilei in a Patient Taking Oral Iron / 대한소화기내시경학회지

Melanosis means the accumulation of brown or black pigment in an organ. Melanosis can be observed in virtually all parts of the gastrointestinal tract. However, it most frequently affects the colon. It is said that melanosis in small intestine is very rare, and no case has been reported in which melanosis was simultaneously noted in duodenum and ileum without involving the colonic mucosa. Here we report a case of melanosis duodeni and melanosis ilei which were found simultaneously in a 56-year-old female patient with chronic renal failure and heart failure who had been taking oral ferrous sulfate for 3 years.

A Case of Pneumonia with Septic Shock Due to Nocardia farcinia in Liver Transplant Patient / 결핵및호흡기질환

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.

Two Cases of Ischemic Colitis after Colonoscopy / 대한소화기내시경학회지

Ischemic colitis is the most common form of ischemia in the gastrointestinal tract. It results from inadequate blood flow in the colon that leads to inflammation of the colon. Though this disease frequently affects the elderly with risk factors of ischemia, younger patients may be affected too. Several conditions such as major vascular occlusion, small vessel disease, shock, some medications, colonic obstructions and hematologic disorders can predispose individuals to ischemic colitis. Ischemic colitis following colonoscopy is rare. Here we report 2 cases of ischemic colitis which developed after colonoscopic procedures in patients without risk factors of ischemia.

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.

Serotype and Antimicrobial Susceptibility of Streptococcus pneumoniae

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.

Serotype and Antimicrobial Susceptibility of Streptococcus pneumoniae

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.

One-staged sinus bone graft using tapered porous surfaced implant in lower residual bone height of maxillary sinus

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2002) / 임상검사와정도관리

Three trials of external quality assessment for clinical microbiology laboratory were performed in 2002. A total of 19 specimens were distributed. Five specimens were distributed to 241 laboratories with 222 returns in Trial I, seven specimens to 241 laboratories with 232 returns in Trial II, and seven specimens to 245 laboratories with 220 returns in Trial III. The percentages of fully correct results of Plasmodium falciparum, P. malariae, P. vivax, gram-positive rods, group 5, S. aureus, E. faecium, Leuconostoc spp. Aeromonas hydrophila, Alternaria spp. S. aureus, E. coli, K. pneumoniae, E. faecalis, P. aeruginosa, E. coli, and K. pneumoniae were 38%, 66%, 68%, 85%, 68%, 94%, 76%, 51%, 86%, 76%, 100%, 99%, 93%, 79%, 86%, 95% and 96%, respectively. The acceptable percentages on disk-diffusion antibacterial susceptibility tests against oxacillin and vancomycin of S. aureus (M0206) were 99% and 94%, respectively. Those against vancomycin and teicoplanin of E. faecium (M0208) were 99% and 94%, respectively. Those against vancomycin, oxacillin, penicillin G, clindamycin, erythromycin, ciprofloxacin, gentamicin and teicoplanin of S. aureus (M0213) were 87%, 95%, 93%, 93%, 93%, 82%, 92%, 99%, and 95%, respectively. The acceptable percentages on disk diffusion test against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0214) were 98%, 100%, 98%, 96%, and 87%, respectively. Those against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0215) were 96%, 100%, 98%, 93% and 99%, respectively. Those against vancomycin, ciprofloxacin, ampicillin, penicillin G, erythromycin, and teicoplanin of E. faecalis (M0216) were 91%, 85%, 94%, 87%, 97%, and 100%, respectively. Those against ciprofloxacin, gentamicin, imipenem, ceftazidime, and piperacillin of P. aeruginosa (M0217) were 89%, 99%, 100%, 100%, and 100%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0218) were 98%, 98%, 98%, 100%, 98%, 100% and 90%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0219) were 97%, 97%, 98%, 100%, 99%, 99% and 99%, respectively. Twenty laboratories on Trial III had reported the both results of disk diffusion and MIC methods. The performance on the automated or E-test susceptibility tests was generally good, except in case of teicoplanin, showing the lower MIC in 63% of 51 participants. The susceptibility against teicoplanin should be confirmed by disk diffusion method in case of vancomycin-resistant Enterococcus in the laboratories using automated MIC methods. In conclusion, it is necessary that the quality assurance of the individual laboratories should be improved in the identification of malaria and Enterococcus spp., and in susceptibility tests against vancomycin, erythromycin and ciprofloxacin of S. aureus, and cephalothin of E. coli in case of disk diffusion method, and teicoplanin of Enterococcus in the laboratories using automated MIC methods.

Perforated Appendicitis Presenting as a Bladder Tumor in a 3 Year-Old Girl / 대한비뇨기과학회지

Large bladder masses in children are extremely rare pathological lesions. They can present as a gross hematuria, with irritable or obstructive voiding symptoms and a urinary tract infection. Their differential diagnosis must include for genitourinary malignancies, such as rhabdomyosarcoma, as well as benign inflammatory lesions. A case of a bladder mass in a three-year-old girl is reported, which was finally diagnosed as localized perforated appendicitis.

A Fistula between Ileal Conduit and Iliac Artery after Radical Cystectomy with Ileal Conduit Urinary Diversion / 대한비뇨기과학회지

A radical cystectomy, including a pelvic lymphadenectomy, is a standard treatment for a muscle invasive bladder tumor, but it is considered a major operation, with serious complications, and most complications develop in the early postoperative period. After a radical cystectomy, with ileal conduit urinary diversion (ICUD), bleeding is a common and well known complication in the early postoperative period, but rare in the later period. Here we report a case of massive bleeding from an ileal conduit 3 months after a radical cystectomy, with ICUD, due to a rupture of the iliac artery pseudoaneurysm, which was treated by vascular suture of the right iliac artery.

Acute Bacterial Meningitis: Causative Organisms, Clinical Characteristics and Prognosis

BACKGROUND: There is a lack of basic epidemiological information on bacterial meningitis in children and adults in Korea. Therefore, more research is needed to investigate the causative organisms, clinical manifestations, and prognosis in Korean children and adults. METHODS: We analyzed retrospectively 148 medical records with final diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on culture-positive cases. RESULTS: Out of a total 148 patients, 71 were children and 77 were adults. In the children with community acquired meningitis, infection-related meningitis was the most common predisposing factor (23.3%). In adults, otitis media was the most common (21.7%). There were more frequent seizures in children than adults (38.1%, 17.1%, p50 years), seizure (p<0.05), and mental change (p<0.001). CONCLUSIONS: Although a causative organism is not documented, we believe that our study will help to properly treat acute bacterial meningitis in children and adults regardless if it is community acquired or nosomial.

Congenital Absence or Hypoplasia of the Internal Carotid Artery: Angiography and HRCT Evaluation at the Skull Base

PURPOSE: To evaluate the findings of angiography and high-resolution CT of the skull base in the patients with congenital absence or hypoplasia of the unilateral internal carotid artery. MATERIALS AND METHODS: Eight patients with congenital unilateral absence (n=6) or hypoplasia (n=2) of the internal carotid artery were included in this study. None showed symptoms related to the absence of the artery. All underwent selective arteriography and six underwent high-resolution CT of the skull base. The angio-graphic findings of the carotid artery and collateral pathways to the absent side, as well as the high-resolution CT findings of the bony carotid canal at the skull base, were evaluated. RESULTS: In all cases, intracranial collaterals were of the adult type. The anterior cerebral arteries were supplied via the anterior communicating artery in all patients, and the middle cerebral arteries via the posterior communicating artery in five. In two, collateral flows were supplied by both the anterior and posterior communicating arteries, and in four, high-resolution CT of the skull base showed remnants or sclerosis of the carotid canal. One patient showed a hypoplastic bony carotid canal, and in one, this canal was absent. Intracranial aneurysms were found in four patients; in three, thses were located at the anterior communicating artery, and in the other, at the posterior cerebral artery. In four of six patients with no internal carotid artery, the ophthalmic arteries were opacified via the middle meningeal artery. CONCLUSION: In cases involving congenital absence or hypoplasia of the internal carotid artery, differentiation between agenesis and aplasia may be based on the pattern of collateral circulation. High-resolution CT find-ings may suggest that this change has a congenital origin.

MR Imaging Findings of Synovial Sarcoma: Emphasis on Signal

PURPOSE: To determine the MR imaging findings of synovial sarcoma, with emphasis on the signal characteristicsof pathologically correlated T2-weighted images. MATERIALS AND METHODS: MR images of 14 cases ofpathologically-proven synovial sarcomas were retrospectively reviewed and correlated with the histopathologicfindings. We analyzed the signal intensity of T1- and T2-weighted images and the incidence of triple signalintensity, and evaluated the frequency of fluid-fluid levels, internal fibrous septa, calcification, the invasionof bone or neurovascular bundles and the involvement of joint capsules, as well as the size, location and marginof the tumors and pattern of contrast enhancement. RESULTS: Necrosis, cystic change or hemorrhage was suggested in11 cases, ten of which showed triple signal intensity, and in all cases, was pathologically confirmed. Fluid-fluidlevels were found in three cases and internal septa in ten. In four cases, maximum diameter was less than 5cm, andin nine, was greater than this. No mass was detected in one case. The tumor was located in the low extremity(n=9),pelvic girdle and hip joint area(n=2), scapular(n=1), shoulder joint area(n=1), and scalp(n=1). Eleven casesshowed a relatively well-defined margin and nine showed lobulation. Except in the area of necrosis and cysticchange, the pattern of contrast enhancement was diffuse and inhomogenous. Bony invasion was detected in two cases,neurovascular encasement in four, calcification in four, and joint capsule invasion in four. CONCLUSION: OnT2-weighted images, synovial sarcoma frequently showed triple signal intensity and internal septa with fluid-fluidlevels ; this was induced by cystic changes due to necrosis and hemorrhage.

MR Findings of Trigeminal Neurinoma

PURPOSE: To describe the MRI findings of trigeminal neurinoma. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1-and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T (8 cases), 1.5T (6 cases) or 0.5T (5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. RESULTS: Clinical manifestations included sensory abnormality or pain (n=12), headache (n=10), impaired visual acuity or diplopia (n=6), hearing loss or tinnitus (n=3), weakness of masticator muscles (n=2), and mass or nasal obstruction (n=2). On MR images, tumor size was seen to average 4.2 (range 1.5-6)cm; tumors were located in the posterior cranial fossa (n=8), middle cranial fossa (n=4), ophthalmic nerve (n=2), maxillarynerve (n=1), and mandibular nerve (n=1), and in three cases were dumb bell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases (53%), and of low intensity in nine (47%); on T2-weighted images, signals were of high intensity in 15 cases (79%) and were isointense in four (21%). Cystic change was seen in 12 cases (63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases (47%) and all of these involved the trigeminal ganglion or mandibular nerve. CONCLUSION: A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen.

Two Cases of Ovarian Pregnancy / 대한산부인과학회잡지

No abstract available.