Predicting Aspiration Using the Functions of Production and Quality of Voice in Dysphagic Patients / 대한연하장애학회지

Objective@#This study aims to identify the usefulness of voice function in early screening for dysphagia. We sought to evaluate if screening tests through the functions of production and quality of voice were correlated with aspiration in dysphagic patients. @*Methods@#This study involved 55 participants who were referred to videofluoroscopic swallowing study (VFSS) for suspected dysphagia. Blinded examiners rated the voice production function (MVI, MPT) using a portable instrument and evaluated the quality of voice (jitter, shimmer, NHR) using Visi-pitch. Swallowing functions were also evaluated by utilizing the penetration-aspiration scale (PAS), American Speech-Language-Hearing Association (ASHA), National Outcome Measurement System (NOMS) swallowing scale and VDS. The patients were divided into two groups, the penetration group, and the aspiration group according to the PAS score. The difference in variables was analyzed using the Mann-Whitney U test between the two groups. The relationship between voice parameters and swallow-related parameters was determined using the Spearman correlation coefficient. In addition, the cut-off, sensitivity, and specificity of meaningful variables in silent aspiration were analyzed using the ROC curve analysis. @*Results@#The functions of production and quality of voice were found to be significantly different between the penetration and aspiration groups (P＜.000). The PAS score was correlated with all parameters of the functions of production and quality of voice (P＜.001). VDS was correlated with MVI, ASHA was correlated with MVI, and Shimmer (P＜.001). The meaningful variables for silent aspiration were jitter and shimmer. @*Conclusion@#Through a clinical screening test, it may be possible to predict the difference between penetration and aspiration through the functions of production and quality of voice.

Atypical Presentation of Chronic Granulomatous Disease in a Neonate with a Pulmonary Granuloma Mimicking a Tumor: A Case Report

Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency caused by phagocytes defective in oxygen metabolite production. It results in recurrent bacterial or fungal infections. Herein, we present a case of CGD with a large pulmonary granuloma in a neonate and review the imaging findings. The patient was a 24-day-old neonate admitted to the hospital with fever. A round opacified lesion was identified on the chest radiograph. Subsequent CT and MRI revealed a round mass with heterogeneous enhancement in the right lower lobe. There were foci of diffusion restriction in the mass. Surgical biopsy of the mass revealed chronic granuloma. Finally, the neonate was diagnosed with CGD caused by mutation of the gp91phox gene. Herein, we present the clinical and imaging findings of this unusual case of CGD.

Covered Self-expandable Metallic Stent Insertion as a Rescue Procedure for Postoperative Leakage after Primary Repair of Perforated Duodenal Ulcer / 대한소화기학회지

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

Computer-Aided Diagnosis of Thyroid Nodules via Ultrasonography: Initial Clinical Experience

OBJECTIVE: To prospectively evaluate the diagnostic performance of computer-aided diagnosis (CAD) for detection of thyroid cancers via ultrasonography (US). MATERIALS AND METHODS: This study included 50 consecutive patients with 117 thyroid nodules on US during the period between June 2016 and July 2016. A radiologist performed US examinations using real-time CAD integrated into a US scanner. We compared the diagnostic performance of radiologist, the CAD system, and the CAD-assisted radiologist for the detection of thyroid cancers. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CAD system were 80.0, 88.1, 83.3, 85.5, and 84.6%, respectively, and were not significantly different from those of the radiologist (p > 0.05). The CAD-assisted radiologist showed improved diagnostic sensitivity compared with the radiologist alone (92.0% vs. 84.0%, p = 0.037), while the specificity and PPV were reduced (85.1% vs. 95.5%, p = 0.005 and 82.1% vs. 93.3%, p = 0.008). The radiologist assisted by the CAD system exhibited better diagnostic sensitivity and NPV than the CAD system alone (92.0% vs. 80.0%, p = 0.009 and 93.4% vs. 88.9%, p = 0.013), while the specificities and PPVs were not significantly different (88.1% vs. 85.1%, p = 0.151 and 83.3% vs. 82.1%, p = 0.613, respectively). CONCLUSION: The CAD system may be an adjunct to radiological intervention in the diagnosis of thyroid cancer.

Effects of Aeration of Sawdust Cultivation Bags on Hyphal Growth of Lentinula edodes

The effects of aeration through lid filters on the hyphal growth of Lentinula edodes (oak mushroom) in sawdust cultivation bags were investigated. The aeration treatment levels were traditional 27 mm hole cotton plugs, cotton balls and combinations of seven hole sizes x two hole positions (up and under) in the lids covering plastic bags containing 1.4 kg sawdust medium at 63% moisture that had been autoclaved for one hour and inoculated with sawdust spawn of L. edodes strain 921. Aeration treatment effects were measured based on the CO2 concentration at the 15th wk, as well as the hyphal growth rate and degree of weight loss of bags every 14 days for 15 wk. In bags with traditional cotton plugs, the CO2 concentration was 3.8 +/- 1.3%, daily mean hyphal growth was 2.3 +/- 0.6 mm and daily mean weight loss was 0.84 +/- 0.26 g. In the bags with 15 mm diameter holes, the CO2 concentration was 6.0 +/- 1.6%, daily hyphal growth was 2.8 +/- 0.2 mm and daily weight loss was 0.86 +/- 0.4 g. The bags with 15 mm holes had a higher CO2 concentration and lower water loss than bags with other hole sizes, but the hyphal growth was not significantly different from that of other bags. The weight loss of bags increased proportionally relative to the lid hole sizes. Taken together, these results indicate that traditional cotton plugs are economically efficient, but 15 mm hole lids are the most efficient at maintaining hyphal growth and controlling water loss while allowing CO2 emissions.

Ki-1 Positive Extranodal NK/T Cell Lymphoma, Nasal Type, Mistaken as Dermatomyositis: A Case Report and Literature Review

We report a case of a 38-year-old male with extranodal NK/T-cell lymphoma, nasal type, showing unusual clinical and pathological features. The patient was admitted for soft tissue swelling and tenderness in both legs. The patient had been treated intermittently 8 months prior for repeated muco-cutaneous ulcers. A muscle biopsy showed medium-sized atypical lymphoid cells with bizarre nuclei and plump cytoplasm, infiltrating to the skeletal muscle fibers with angiocentricity. The immunoresults were Ki-1+, CD56+, cytoplasmic CD3+, with EBV-in situ hybridization +. The patient rapidly deteriorated and died of sepsis and respiratory failure shortly after initiation of low-dose chemotherapy. A careful review of previous biopsies revealed scarce atypical lymphoid cells around vessels with similar immunoprofiles without the presence of Ki-1 positive cells. This case emphasizes that an extranodal NK/T-cell lymphoma may have a dermatomyositis-like diffuse presentation. Ki-1 co-expression can be an unexpected event in a process of the disease course; however, this should be validated with future studies.

Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia / 대한혈액학회지

BACKGROUND: The outcome of hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA) in Seoul National University Hospital was analyzed retrospectively. METHODS: Between January, 1990 and March, 1999, 25 patients with SAA underwent HSCT. Their medical records were reviewed. Statistical analyses were done about survival and complication after HSCT. RESULTS: The median age of patients was 22 (range, 14~43) and male to female ratio was 18 : 7. Twenty two were HLA matched non- identical siblings. Three were one identical twin, one one-locus mismatched father and one HLA matched unrelated donor, respectively. Conditioning regimens were CY/TLI (cyclophosphamide, total lymphoid irradiation) for 18 patients, CY/ATG (CY, antithymocyte globulin) for 3, CY/ buffy (CY, unirradiated buffy- coat) for 2, CY/ ATG/TLI for 1, BU/CY (busulfan, CY) for 1. For prophylaxis of graft-versus-host disease (GVHD), cyclosporine and methotrexate were used in all patients except for identical twin. The median nucleated cell dose given to patients was 4.5x108/kg (range, 2.0~5.9). All evaluable patients achieved absolute neutrophil count of 500/microliter after median 17 days of HSCT (range, 12~27) and untransfused platelet count over 20,000/microliter after median 21 days of HSCT (range, 13~67). Six patients (24%, grade I : 3, II : 1, III : 1, IV : 1) developed acute GVHD and 8 (32%, limited : 4, extensive : 4) developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 2 patients (8%). Rejection occured in 4 patients (16 %), but among 22 allogeneic transplant recipients from HLA matched siblings, only one (5%) lost graft. After a median follow-up of 32 months (range 9~120 months), 5 year overall survival of all patients was 87%, and that of 22 allogeneic recipients from HLA matched sibling donors was 95%. Four patients (16%) died. Causes of death were VOD in one case, rejection with pneumonia one, acute GVHD one. One died from traffic accident in a cured state. CONCLUSION: Experiences from our center suggest that HSCT is an effective treatment for patients with severe aplastic anemia. Long- term survival is especially excellent for patients who have matched related donors.

Allogeneic Bone Marrow Transplantation for Acute Myelogenous Leukemia: Retrospective Analysis in a Single Institution / 대한혈액학회지

BACKGROUND: Acute myelogenous leukemia (AML) is the most common cause of leukemia in adults. Allogeneic bone marrow transplantation (BMT) for the treatment of AML is done worldwide now. METHODS: Between November 1987 and June 1998, we performed allogeneic BMT for 27 patients with AML from HLA-identical sibling donors. We reviewed medical records of these patients. RESULTS: The median age of patients was 31 (range, 15~43) and male to female ratio was 18 : 9. Conditioning regimens were BU/CY (busulfan, cyclophosphamide) for 22 patients, TBI/CY (total body irradiation, cyclophosphamide) for 3 patients, and TBI/VP/CY (TBI, VP-16, cyclophosphamide) for 2 patients. Cyclosporine and methotrexate were used in 18 patients for prophylaxis of graft-versus-host disease (GVHD), and cyclosporine and methyl-prednisolone were used in 9 patients. The median nucleated cell dose given to patients was 4.1x108 /kg. All evaluable patients achieved absolute neutrophil count of 500 /microliter after median 15 days after BMT (range, 11~45 days). Twenty-five percent of patients developed acute GVHD (> or = grade II) and there was no patient with grade IV acute GVHD. Twenty-nine percent developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 7 patients (26%). At the time of BMT, 16 patients were in the first remission status and 11 patients were in the advanced disease status. After a median follow-up of 27 months (range 7~127 months), the actuarial disease-free survival at 5 years was significantly higher in the first remission group than the others (44% vs. 9%; P=0.05). The difference of 5 year overall survival between these two groups approached statistical significance (50%for the first remission group and 12% for the others; P=0.13). There were 17 deaths. The causes of death were relapse (8 patients, 47%), VOD (3 patients, 18%), sepsis (2 patients, 12%), interstitial pneumonia (2 patients, 12%), chronic GVHD (1 patient, 6%), and drug-toxicity (1 patient, 6%). Eary deaths (<100 days) occurred in 6 patients (22%). CONCLUSION: Allogeneic BMT for patients with AML was most successful when done during the first remission. Clinical features of patients with AML treated with allogeneic BMT were similar to those from Western countries, but the incidence and severity of acute GVHD seem to be lower.

The Long-term Effect of Induction Chemotherapy with All-trans-retinoic Acid(ATRA) Follwed by Consolidation Chemotherapy for Newly Diagnosed Acute Promyelocytic Leukemia / 대한혈액학회지

No abstract available.

A Phase 2 Study with Vinorelbine and Ifosfamide in the Inoperable Non - small Cell Lung Cancer / 대한암학회지

PURPOSE: A phase II study of vinorelbine and ifosfamide combination chemotherapy in patients with advanced or recurrent non-small cell lung cancer (NSCLC) was conducted to assess response rate, response duration, and toxicites. MATERIALS AND METHODS: Patients with advanced NSCLC who had no prior systemic chemotherapy were eligible. They have no central nervous system metastasis and recurrent or progressive disease after surgery or radiotherapy. Each cycle consisted of vinorelbine 25 mg/m' i.v. days 1 & 8, and ifosfamide 2 g/m i.v. days 1, 2 & 3 with Mesna and treatments were repeated every 21 days. RESULTS: Forty patients with advanced or recurrent NSCLC were treated at multi center between March, 1997 and March, 1998. Six patients were not evaluable because five patients refused therapy after the first course and one patient was protocol violation. Of 34 evaluable patients, objective responses were seen in 11 (32.4%) patients (CR 0%, PR 32.4%). The median duration of response was 16.4 weeks. The median overall survival was 9.5 months. The toicities of this regimen were acceptable without treatment related toxic death. CONCLUSION: We concluded that combination regimen of vinorelbine and ifosfamide was effective and tolerable in the treatment of advanced non-small cell lung cancer.