Effectiveness of Rehabilitative Balloon Swallowing Treatment on Upper Esophageal Sphincter Relaxation and Pharyngeal Motility for Neurogenic Dysphagia

OBJECTIVE: To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD). METHODS: We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment. RESULTS: Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738). CONCLUSION: The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation.

Correlation of Appearance of Nasal Eosinophils with Levels of Total Eosinophil Counts, Total IgE, and House Dust Mite Specific IgE in Children with Symptoms of Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: Nasal cytology for eosinophils has been reported to be very useful for the diagnosis of allergic rhinitis. The purpose of this study is to describe the relationship of the appearance of nasal eosinophils with the levels of total eosinophil counts, total IgE, and house dust mite specific IgE in child patients with symptoms of rhinitis. METHODS: Two hundred seventy eight children with symptoms of rhinitis less than 16 years of age were recruited and evaluated for the following variables: total eosinophil counts, total IgE concentrations, house dust mite specific IgE concentrations, and nasal cytology for eosinophils. RESULTS: The rate of appearance of nasal eosinophils graded as positive rose as the children's age increased. The levels of total eosinophil counts, total IgE concentrations and house dust mite-specific IgE concentrations were significantly higher in children with nasal eosinophils graded as positive than those with less than 5 percent of nasal eosinophils. The rates of appearance of nasal eosinophils graded as positive below and above 250/microL of total eosinophil counts, 250 kUa/L of total IgE concentrations, and 2 kUa/L of house dust mite (D. pteronyssinus or D. farinae) specific IgE concentrations were 16 and 41 percent, 27 and 56 percent, and 13 and 68 percent, respectively CONCLUSION: The levels of total eosinophil counts, total IgE concentrations, and house dust mite specific IgE concentrations correlate significantly with the recovery of nasal eosinophils in children with symptoms of rhinitis.

A case of secondary amyloidosis presenting acute renal failure in rheumatoid arthritis patient / 대한내과학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Deposition of amyloid may cause widespread dysfunction of the involved organs. A secondary amyloidosis is AA amyloidosis and rheumatoid arthritis is one of the main underlying disease. We report a case of secondary amyloidosis in a 52 year old woman with rheumatoid arthritis. She had suffered from rheumatoid arthritis for 17 years and her hands and feet were deformed. She was presented with oliguric acute renal failure. She was confirmed by showing apple green birefringence under the polarized microscope with Congo-red stain through renal and rectal biopsy. We couldn't find any previous report of the secondary amyloidosis among the patients presenting oliguric acute renal failure without proteinuria in the Korean literatures.

Association of IL-10 Gene Polymorphism with Development of Atopy / 소아알레르기및호흡기학회지

PURPOSE: There has been accumulating evidence that interleukin-10 (IL-10) influences on the production of proinflammatory cytokines, regulating the development of atopic diseases. In this study, we tested the genetic association between IL-10 haplotype polymorphism and the development of atopy. METHODS: The frequency of three single nucleotide polymorphisms (SNPs) at positions- 1082 (A/G), -819 (C/T), -592 (A/C) and corresponding haplotypes in the promotor region of the IL-10 gene were analysed in 174 atopic and 130 non-atopic children using Taqman method. The data were assessed for correlations with the eosinophil count and total serum IgE concentration. RESULTS: Three haplotypes (ATA, ACC, GCC) were identified without any ambiguous phasing due to linkage disequilibrium among SNPs. The frequency of IL-10 haplotype ACC was higher in non-atopic children compared to atopic children. (P=0.04) The frequency of IL-10 haplotype ATA was higher in atopic children compared to non-atopic children, but a statistical significance was not found. (P=0.099) ATA/ATA and ATA/ACC accounted for 80 percent of six different genotypes. Although the frequency of ATA/ATA genotype was higher in atopic children, there was no statistical significance. Although medians of serum IgE level and total eosinophil count were higher among atopic children with ATA/ATA genotype than in atopic children with ATA/ACC, no statistical significance was found. CONCLUSION: These results suggest that IL-10 promotor polymorphism may be associated with a genetic risk factor for the development of atopy in Korean children.

A case of hydrothorax in peritoneal dialysis / 대한내과학회지

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for the end stage renal disease. The hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. A variety of symptoms are complained. The regular chest X-ray and pleural fluid examination are needed to find out this complication with vague symptoms. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication). Several treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. We have recently managed with a patient CAPD-induced massive hydrothorax with decreased amount of effluent dialysate volumes using talc pleurodesis. This patient was successfully returned to CAPD.

Gouty Tophus on the Tibial Tuberosity with Accompanied Chemical Cellulitis Localized at the Upper Tibia / 대한류마티스학회지

Gout is characterized by hyperuricemia and recurrent attacks of acute arthritis. Gout is a clinical syndrome resulting from the deposition of urate (monosodium urate monohydrate) crystals. Urate deposition occurs in articular cartilage, subchondral bone, synovial membrane, joint capsule and periarticular tissues, with articular cartilage being especially susceptible. The first metatarsophalangeal joint is commonly involved at presentation and other commonly affected joints are the ankle, knee and tarsal area. Gouty tophus located on the tibial tuberosity has never been reported in korea. We report a case of gouty tophus on the tibial tuberosity with (chemical) cellulitis occurred at the upper tibial area in a 46- year-old man.

Comparison of efficacy and safety of simvastatin, 10 mg and 20 mg in the treatment of hypercholesterolemia / 대한내과학회지

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day. METHODS: One hundred six patients with hyperlipidemia (triglycerides130 mg/dL) were randomized to receive either simvastatin 10 mg/day (n=43) or 20 mg/day (n=63). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol. RESULTS: Of the one hundred six patients randomized to treatment, forty patients were men and sixty-six patients were women. Fifty-five percent of patients had hypertension, nine percent coronary artery disease and thirteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 258 (total cholesterol), 201 (triglycerides), 50 (HDL) and 167 mg/dL (LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters (p< 0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater (p< 0.001) reductions from baseline LDL cholesterol (34.9 mg/dL vs 20.8 mg/dL). But 10 mg of simvastatin was more effective than 20 mg of simvastatin at reducing triglycerides level (42.7 mg/dL vs 22.3 mg/dL). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline (ATP III) were 81% and 80% for patients in low risk but 35% and 50% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients (4.8%) in the 20 mg group and one patient (2.3%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION : In patients with hypercholesterolemia in Korea, both doses (10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients' preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.