Clinical Analysis of Dizziness Patients Who Visited Emergency Room / 대한이비인후과학회지

Background and Objectives@#Dizziness has diverse underlying causes, so the diagnosis is challenging especially in the emergency room. The aim of this study is to identify clinical characteristics of patients’ complaints of dizziness in the emergency room.Subjects and Method We retrospectively reviewed the medical records of 10367 patients who visited the emergency room with the chief complaint of dizziness from January 2016 to December 2020. Patients’ clinical information including age, sex, final diagnoses, consulting departments, treatment results and seasonal incidences were thoroughly assessed. @*Results@#Of the total patients who visited the emergency room, 4.64% complained of dizziness. The mean age of patients was 57.6 years old. The most common age group was over 70’s (28.1%). There were 6322 (61.1%) female patients, while 4035 (38.9%) were male patients. Nearly half 4932 (47.6%) of the patients were managed by the emergency department, followed by 3204, who were managed by the department of otolaryngorhinology (30.9%), and 1166 (11.2%) managed by the neurology department. The dizziness was classified as peripheral vertigo (33.8%), nonspecific dizziness (27.4%), medical conditions (13.9%), central dizziness (11.0%), cardiac dizziness (6.2%), and other miscellaneous causes of trauma, neoplasm and psychogenic causes (7.7%). In peripheral vertigo, the incidence of BPPV, vestibular neuritis and Meniere’s disease were 23.5%, 8.8% and 0.6%, respectively. @*Conclusion@#Peripheral vertigo accounted for the majority for the patients with chief complaints of dizziness in the emergency room. As diverse medical conditions may cause dizziness, specialized departments have to be involved in the diagnostic process of dizziness.

Introduction of Multidisciplinary Team Approach for Head and Neck Cancer: Patient Satisfaction / 대한이비인후과학회지

Background and Objectives@#The head and neck multidisciplinary team (MDT) approach plays a crucial role in bringing together the ideas of various medical professionals. This study aimed to evaluate the early characteristics of the MDT approach for head and neck cancer and analyzed patients’ satisfaction.Subjects and Method We analyzed 450 head and neck cancer patients who received MDT care from August 2014 to June 2022. Patient satisfaction with MDT care was evaluated by selfadministered questionnaires consisting of 9 questions. @*Results@#Of 450, 298 (66.2%) were male and 152 (33.8%) were female. The mean age was 60.8±14.7 year. The most common primary site was the larynx (17.3%), followed by the oral cavity and oropharynx. A total of 726 cases of the MDT approach were performed in 266 MDT sessions, and the mean number of patients per MDT session was 2.74. The number of medical professionals participating in MDT ranged from a minimum of 3 to a maximum of 9, with a mean of 5.11. The mean running time of MDT meetings per case was 19.51 minutes. The time of the 2nd MDT was significantly shorter than that of the 1st or 3rd MDT. The mean score was close to very satisfactory in each of the 9 patient satisfaction questions. @*Conclusion@#We believe that the MDT approach is feasible and recommend its introduction for the treatment of head and neck cancer as most patients have shown very high satisfaction. Further studies on the role and efficacy of MDT care for head and neck cancer are necessary.

Common ABCB1 SNP, C3435T could affect systemic exposure of dapagliflozin in healthy subject

P-glycoprotein (P-gp) is a transporter that plays an excretory role in epithelial cells. It is encoded by ABCB1, and single nucleotide polymorphisms (SNPs) in this gene can affect systemic drug exposure. Dapagliflozin and sitagliptin, used in type 2 diabetes treatment, are P-gp substrates. Here, we aimed to investigate whether ABCB1 polymorphisms affect dapagliflozin and sitagliptin pharmacokinetics (PK) in healthy Korean subjects.The study population consisted of 100 healthy Korean subjects (94 men and 6 women) who participated in four different clinical trials and received dapagliflozin and sitagliptin doses of 10 and 100 mg, respectively. We determined ABCB1 genotypes for the C3435T, C1236T, and G2677T/A SNPs. The relationship between the genotypes and dapagliflozin PKs was examined.Dapagliflozin and sitagliptin PK parameters were not statistically significantly affected by ABCB1 SNP genotypes. However, homozygous 3435TT subjects showed higher dapagliflozin PK parameters than CT and CC subjects. In subjects with the 3435TT and those with 3435CC and 3435CT genotypes, mean Cmax, AUCinf, and AUC0-1 values of dapagliflozin were 223.06 ng/mL and 194.81 ng /mL (p = 0.2767), 673.58 ng*h/mL and 573.96 ng*h/mL (p = 0.0492), and 128.53 ng*h/mL and 104.61 ng*h/mL (p = 0.2678), respectively.In summary, dapagliflozin and sitagliptin PK parameters were not significantly different between individuals with C1236T and C2677T/A ABCB1 genetic polymorphisms. Dapagliflozin exhibited higher systemic exposure in 3435TT subjects than in CC/CT subjects.

A Case of Buccal Pilomatricoma Removed Through Intraoral Incision / 대한두경부종양학회지

Pilomatricoma(or calcifying epithelioma) is a not common benign solitary tumor originated from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. The tumor usually presents as an asymptomatic, hard, superficial located, and skin colored to reddish blue cutaneous mass. Most of the tumors are less than 10mm in diameter and adherent to the skin. Recently, 48-year-old man presented with cheek mass. The tumor was 2.6cm sized and located at the subcutaneous layer of cheek on CT scan. The tumor was clearly removed via transoral approach with buccal incision leaving no wound on face. The mass was confirmed as pilomatricoma on pathologic examination. Herein, we report our experience with literature review.

Azathioprine-Induced Non-Cirrhotic Portal Hypertension in a Patient with Crohn’s Disease / 대한내과학회지

Thiopurine-based drugs such as azathioprine and 6-MP are among the most common immunosuppressants used to treat inflammatory bowel disease, autoimmune hepatitis, various autoimmune diseases, and patients undergoing organ transplantation. The drugs are associated with various complications, of which one of the most serious is hepatotoxicity that may trigger non-cirrhotic portal hypertension. We report a case with this side-effect in a patient taking azathioprine to treat Crohn’s disease.

Determination of donepezil in human plasma using ultra performance liquid chromatography-tandem mass spectrometry

An ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the quantification of donepezil in human plasma. Donepezil and donepezil-D4 were extracted from human plasma by liquid-liquid extraction using a mixture of hexane and ethyl acetate (70:30 v/v). The extracted samples were analyzed using a Thermo Hypersil Gold C18 column with 5% acetic acid in 20 mM ammonium acetate buffer (pH 3.3) and 100% acetonitrile as a mobile phase with the 60:40 (v:v) isocratic method, at a flow rate of 0.3 mL/min. The injection volume was 3 µL, and the total run time was 3 min. Inter- and intra-batch accuracies ranged from 98.0% to 110.0%, and the precision was below 8%. The developed method was successfully applied to the quantification of donepezil in human plasma. The mean (standard deviation) maximum concentration and the median (range) time to maximum concentration were 8.6 (2.0) ng/mL and 2.0 h (1.0~5.0 h), respectively, in healthy Koreans after oral administration of 5 mg donepezil.

A Case of Pulmonary Paragonimiasis with Chronic Abdominal Pain and Erythematous Rash in a 6-year-old Girl

Pleural paragonimiasis is uncommon in the pediatric population and therefore can be challenging to diagnose. This is a case of a 6-year-old girl with pleural effusion who had been having intermittent persistent epigastric pain and erythematous rash on the face, hands, and arms for 6 months. Exudative pleural effusion with prominent eosinophils and serum eosinophilia were observed. As patient showed high immunoglobulin M (IgM) titers against Mycoplasma pneumoniae , she was treated with antibiotics; however, the pleural effusion did not improve during hospitalization. Despite showing negative stool ova and cyst results, patient's serum and pleural effusion were positive for Paragonimus westermani-specific IgGs on enzyme-linked immunosorbent assay. Respiratory symptoms, pleural effusion, and skin symptoms improved after praziquantel treatment.

Incidence of pterygospinous and pterygoalar bridges in dried skulls of Koreans / 대한해부학회지

Understanding of morphological structures such as the sphenoid spine and pterygoid processes is important during lateral transzygomatic infratemporal fossa approach. In addition, osseous variations such as pterygospinous and pterygoalar bridges are significant in clinical practice because they can produce various neurological disturbances or block the passage of a needle into the trigeminal ganglion through the foramen ovale. Two hundred and eighty-four sides of Korean adult dry skulls were observed to carry out morphometric analysis of the lateral plate of the pterygoid process, to investigate, for the first time among Koreans, the incidence of the pterygospinous and pterygoalar bony bridges, to compare the results with those available for other regional populations, and to discuss their clinical relevance as described on literatures. The mean of maximum widths of the left and right lateral plates of the pterygoid process were 15.99 mm and 16.27 mm, respectively. Also, the mean of maximum heights of the left and right lateral plates were 31.02 mm and 31.01 mm, respectively. The ossified pterygospinous ligament was observed in 51 sides of the skulls (28.0%). Ossification of the pterygospinous ligament was complete in four sides (1.4%). In 47 sides (16.6%), the pterygospinous bridge was incomplete. The ossified pterygoalar ligament was observed in 24 sides of the skulls (8.4%). Ossification was complete in eight sides (2.8%) and incomplete in 16 sides (5.6%). This detailed analysis of the lateral plate of the pterygoid process and related ossification of ligaments can improve the understanding of complex clinical neuralgias associated with this region.

Extra-Articular Ganglion Cysts around the Knee Joint

PURPOSE: The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. MATERIALS AND METHODS: Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. RESULTS: The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. CONCLUSIONS: In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.

Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

PURPOSE: Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula. METHODS: From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up. RESULTS: All fractures achieved anatomical reduction and united at final follow-up. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22. CONCLUSION: Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.

Lower Loading Dose of Prasugrel Compared with Conventional Loading Doses of Clopidogrel and Prasugrel in Korean Patients Undergoing Elective Coronary Angiography: A Randomized Controlled Study Evaluating Pharmacodynamic Efficacy

BACKGROUND AND OBJECTIVES: Although prasugrel allows for rapid and potent platelet inhibition, the efficacy and safety of lower doses of prasugrel for patients of East Asian ethnicity has not yet been investigated. We compared the effect of a lower loading dose (LD) of prasugrel with conventional LDs of clopidogrel and prasugrel in Korean patients. SUBJECTS AND METHODS: Forty-three Korean patients undergoing coronary angiography were enrolled in the study. Participants were randomly administered LDs of clopidogrel 600 mg, prasugrel 30 mg or prasugrel 60 mg prior to coronary angiography. Platelet reactivity was assessed at baseline and at the time of peak platelet inhibition using light transmission aggregometry (LTA), the VerifyNow assay, and multiple electrode aggregometry. RESULTS: Although baseline platelet reactivity between the groups showed no significant differences, at the time of peak platelet inhibition, the prasugrel 30 mg (18.9+/-10.0%) and 60 mg groups (13.8+/-10.8%) showed significantly more potent platelet inhibition than the clopidogrel 600 mg group (52.9+/-15.8%; p<0.001) by LTA. However, there were no significant differences between the prasugrel 30 mg and 60 mg groups (p=0.549). CONCLUSION: The loading effect of prasugrel 30 mg was more potent than clopidogrel 600 mg and was not significantly different from prasugrel 60 mg.

Morphometric Study of the Retromolar Triangle and Foramen in Korean Mandibles / 체질인류학회지

It has been known that the retromolar foramen is a rare anatomic variation observed in the retromolar triangle, a small triangular shaped region posterior to the mandibular third molar. Due to the neurovascular bundle passing through the retromolar foramen, this anatomical structure must be kept in mind during surgical approaches regarding the retromolar area and mandible. Therefore, the authors investigated the morphology of retromolar triangle and the existence and location of retromolar foramen in Korean. And these results were compared with that of other races. We used 308 sides of 154 Korean dry mandibles, unknown gender and age. The retromolar triangle presented predominantly a triangular shape (84.1%), and the maximum height and width were 13.7 mm and 7.1 mm, respectively. In 144 of the 308 sides, the retromolar foramen was observed (46.8%). The existence of the retromolar foramen was seen the same frequency in both sides, and based on a midsagittal line of the retromolar triangle, the retromolar foramen located in more buccal side (75%) than lingual side. The mean distance between the retromolar foramen and the distal edge of the last tooth were found to be 10.3 mm and 6.9 mm, respectively for the second and third molars. According to the present study, the northeast Asians including Korean population show the highest rate of the incidence of the retromolar foramen than other races. The findings suggest that practitioners should take the retromolar foramen into account in surgical procedures involving the retromolar area to protect the patient from the complications such as bleeding or nerve damage.

A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding / 대한소화기학회지

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

Relationship between Antiphospholipid Antibodies and Major Adverse Cardiovascular Events after Drug-Eluting Stent Implantation in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Several studies have reported an association between antiphospholipid antibodies (APA) and major adverse cardiovascular events (MACE) following acute myocardial infarction (AMI). However, the relationship between APA and the prognosis after drug-eluting stent (DES) implantation in patients with AMI is not known. METHODS: Thus, we investigated the relationship between the incidence of MACE and APA levels in patients with AMI who underwent successful DES implantation. RESULTS: Of 182 patients, 78 (42.9%) tested positive for APA. Lupus anticoagulant was positive in 37.6% (68 of 181) patients, anticardiolipin antibody IgM was positive in 8.3% (15 of 180), and anticardiolipin antibody IgG was positive in 1.7% (3 of 180) patients. At follow up, a MACE had occurred in 11 (14.1%) patients in the APA-positive group and in seven (6.7%) patients in the APA-negative group (p = 0.099). CONCLUSIONS: No significant association was found between the incidence of MACE and the presence of APA in patients with AMI who underwent successful DES implantation.

Midazolam protects B35 neuroblastoma cells through Akt-phosphorylation in reactive oxygen species derived cellular injury / 대한마취과학회지

BACKGROUND: Soman, a potent irreversible acetylcholinesterase (AChE) inhibitor, induces delayed neuronal injury by reactive oxygen species (ROS). Midazolam is used in patients with pathologic effects of oxidative stresses such as infection, hemodynamic instability and hypoxia. We investigated whether midazolam protects the Central Nervous System (CNS) from soman intoxication. The present study was performed to determine whether midazolam protects B35 cells from ROS stress for the purpose of exploring an application of midazolam to soman intoxication. METHODS: Glucose oxidase (GOX) induced ROS stress was used in a B35 neuroblastoma cell model of ROS induced neuronal injury. To investigate the effect of midazolam on cell viability, LDH assays and fluorescence activated cell sorting (FACS) analysis was performed. Western blotting was used for evaluating whether Akt-phosphorylation is involved in cell-protective effects of midazolam. RESULTS: GOX derived ROS injury decreased cell viability about 1.6-2 times compared to control; midazolam treatment (5 and 10 microg/ml) dose-dependently increased cell viability during ROS injury. On western blots, Akt-phosphorylation was induced during pretreatment with midazolam; it was diminished during co-treatment with LY-294002, an inhibitor of Akt-phosphorylation. FACS analysis confirmed that the cell protective effect of midazolam is mediated by an anti-apoptotic effect. GOX-induced apoptosis was inhibited by midazolam and the finding was diminished by LY-294002. CONCLUSIONS: Midazolam protects neuronal cells from GOX-induced ROS injury; this effect is mediated by an anti-apoptotic effect through Akt-phosphorylation. This shows that midazolam may be useful in soman intoxication.

A comparison of fixation methods using three-dimensional finite element analysis following anterior segmental osteotomy

OBJECTIVES: This study sought to evaluate fixation methods and determine the best method for the postoperative stabilization of maxillary osteotomy. For our analysis we performed a three-dimensional finite element analysis of stress distribution on the plate, screw, and surrounding bone, as well as displacement onto the plate. MATERIALS AND METHODS: We generated a model using synthetic skull scan data; an initital surface model was changed to a solid model using software. Modified anterior segmental osteotomy (using Park's method) was made using the program, and four different types of fixation methods were used. An anterior load of 100 N was applied on the palatal surface of two central incisors. RESULTS: The Type 1 (L-shaped) fixation method gave stresses of 187.8 MPa at the plate, 45.8 MPa at the screw, and 15.4 MPa at the bone around the plate. The Type 2 (I-shaped) fixation method gave stresses of 186.6 MPa at the plate, 75.7 MPa at the screw, and 13.8 MPa at the bone around the plate. The Type 3 (inverted L-shaped) fixation method gave stresses of 28.6 MPa at the plate, 29.9 MPa at the screw, and 15.3 MPa at the bone around the plate. The Type 4 (I-shaped) fixation method gave stresses of 34.8 MPa at the plate, 36.9 MPa at the screw, and 14.9 MPa at the bone around the plate. The deflection of the plates for the four fixation methods was 0.014 mm, 0.022 mm, 0.017 mm, and 0.018 mm, respectively. CONCLUSION: The Type 3 (inverted L-shaped) fixation method offers more stability than the other fixation methods. We therefore recommend this method for the postoperative stabilization of maxillary osteotomy.

Obstructive Sleep Apnea of Achondroplasia Treated With Continuous Positive Airway Pressure

No abstract available.

A Case of Pancreatic Cancer and Opioid Withdrawal after Endoscopic Ultrasound-guided Celiac Plexus Neurolysis / 대한소화기내시경학회지

Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.

Kinetic Changes of COX-2 Expression during Reperfusion Period after Ischemic Preconditioning Play a Role in Protection Against Ischemic Damage in Rat Brain

A brief ischemic insult induces significant protection against subsequent massive ischemic events. The molecular mechanisms known as preconditioning (PC)-induced ischemic tolerance are not completely understood. We investigated whether kinetic changes of cyclooxygenase (COX)-2 during reperfusion time-periods after PC were related to ischemic tolerance. Rats were given PC by occlusion of middle cerebral artery (MCAO) for 10 min and sacrificed after the indicated time-periods of reperfusion (1, 2, 4, 8, 12, 18 or 24 h). In PC-treated rats, focal ischemia was induced by occlusion of MCA for 24 h and brain infarct volume was then studied to determine whether different reperfusion time influenced the damage. We report that the most significant protection against focal ischemia was obtained in rats with 8 h reperfusion after PC. Administration of indomethacin (10 mg/kg, oral) or rofecoxib (5 mg/kg, oral) 48 h prior to PC counteracted the effect of PC. Immunohistochemical analysis showed that COX-2 and HO-1 protein were induced in PC-treated rat brain, which was significantly inhibited by rofecoxib. Taken together, we concluded that the kinetic changes of COX-2 expression during the reperfusion period after PC might be partly responsible for ischemic tolerance.

The hypermethylation of E-cadherin gene in oral squamous cell carcinoma

Loss of E-cadherin (E-cad) expression has been found in multiple cancers and is postulated to facilitate tumor cell dissociation and metastais. Promotor methylation may provides an alternative pathway for loss of gene function. This study evaluated the role of hypermethylation in the down-regulation of E-cad in oral squamous cell carcinoma (OSCC). We examined the E-cad expression by immunohistochemical staining and detected methylation status by methylation-specific polymerase chain reaction (MSP) in 20 OSCC tissues. Overally, 12 (60 %) cases of hypermethylation of E-cad were detected and we found there were no correlation between methylation and age, histologic grade, lympn node metastasis, tumor size and clinical stage. However, Eleven (73.3 %) of 15 samples which was negative for E-cad staining showed hypermethylation of E-cad promotor region. On the other hand, only one (20 %) of 5 E-cad positive sample was observed with methylated status. The underexpression of E-cad was found to be related to promotor hypermethylation (p=0.035). In conclusion, we suggest that hypermethylation play a role in inactivation of E-cad gene and may be a appreciable biomarker for diagnosis and treatment of OSCC.