Development of High-Intensity Focused Ultrasound Therapy for Inferior Turbinate Hypertrophy

Objectives@#. Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy. @*Methods@#. First, computed tomography images of patients with no evidence of sinonasal disease were evaluated to measure and compare the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on the above human anatomical studies. The experimental study was performed in five pigs; the nasal volume and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and a control group. @*Results@#. The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial space was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm, respectively. HIFU showed no postoperative complications, including bleeding or scar formation. After HIFU treatment, the nasal volume increased by 196.62 mm3 (7.8%) and 193.74 mm3 (8.3%) at 1 week and 4 weeks, compared with the increase of 87.20 mm3 (3.1%) and 213.81 mm3 (9.0%), respectively,after radiofrequency therapy. A qualitative histological analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis, along with decreased glandular structure, at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis and decreased glandular structure. @*Conclusion@#. The efficacy and safety of HIFU turbinoplasty were demonstrated in an animal study. Our results warrant further human clinical trials.

An Imported Case of Disseminated Echinococcosis in Korea

A complicated case of echinococcosis with multiple organ involvement is reported in a 53-year-old businessman who frequently traveled overseas, including China, Russia, and Kazakhstan from 2001 to 2007. The patient was first diagnosed with a large liver cyst during a screening abdomen ultrasonography in 2011, but he did not follow up on the lesion afterwards. Six years later, dizziness, dysarthria, and cough developed, and cystic lesions were found in the brain, liver and lungs. The clinical course was complicated when the patient went through multiple surgeries and inadequate treatment with a short duration of albendazole without a definite diagnosis. The patient visited our hospital for the first time in August 2018 due to worsening symptoms; he was finally diagnosed with echinococcosis using imaging and serologic criteria. He is now on prolonged albendazole treatment (400 mg twice a day) with gradual clinical and radiological improvement. A high index of suspicion is warranted to early diagnose echinococcosis in a patient with a travel history to endemic areas of echinococcosis.

The clinical manifestations and outcomes of neuralgic amyotrophy

Background & Objective: Although the clinical manifestations and outcomes of neuralgic amyotrophy have been previously described, some controversies remain. Thus, we evaluated clinical manifestations and outcomes of patients with neuralgic amyotrophy. Methods: We evaluated the clinical and electrodiagnostic data, and the outcomes, of 32 patients with neuralgic amyotrophy.Of the 32 patients, 26 were followed-up for one year after onset of the disease.Results:The initial symptoms were pain (50.0%), pain with weakness (21.9%), other sensory symptoms without weakness (6.3%), and painless weakness or atrophy (21.9%). The commonly involved nerves were the median (75.0%), radial (68.8%), suprascapular (50.0%), ulnar (50.0%), axillary (46.9%), and musculocutaneous (40.6%) nerves. The initial symptoms were not associated with nerve involvement. Of all patients, 59% recovered fully, 16% had residual mild weakness without functional disability, and 6% experienced persistent severe weakness and were unable to return to work. Some patients were not evaluated because they were lost to follow-up. Conclusions: Painless weakness as an initial symptom of neuralgic amyotrophy may be more common than previously noted. Of all patients, 75% enjoyed favorable outcomes by one year after disease onset. These results will be useful when planning treatment strategies and will deepen our understanding of prognosis of neuralgic amyotrophy.

Two Cases of Quadricuspid Aortic Valve Associated with Aortic Regurgitation and Infective Endocarditis

Quadricuspid aortic valves (QAVs) is a rare congenital malformation. We report two cases of QAV associated with aortic regurgitation. The one is incidentally diagnosed and uncomplicated, and the other is symptomatic and associated with infective endocarditis. In most cases, QAVs are associated with valve regurgitation, with a concurrent stenosis in some patients, while only a small number of QAVs are functionally normal. Once the diagnosis has been made, echocardiographic follow-up is recommended, because of progression to severe valve regurgitation and the risk of infective endocarditis.

A Case of Aloe-nduced Acute Interstitial Nephritis / 대한신장학회잡지

We report a case of aloe induced acute interstitial nephritis in a 66-year old man. He had been taken aloe as a healthy foodstuff for 6 weeks prior to admission. He complained poor oral intake and developed nonoliguric acute renal failure. Renal biopsy revealed focal tubular atrophy and interstitial infiltration of neutrophils, and lymphocytes. After discontinuation of aloe and high dose prednisolone therapy, acute renal failure of the patient improved and serum creatinine level decreased.

The Expression of MMPs and TIMPs in IPF and NSIP / 결핵및호흡기질환

BACKGROUND: MMPs and TIMPs are important factors for abnormal remodeling the pulmonary parenchyme in idiopathic interstitial pneumonia(IIP) This study evaluated the expression of MMPs and TIMPs in the tissue of IPF, NSIP and normal control subjects. METHOD: The MMP-2 and -9 activity in the lung tissue was studied by gelatin zymography, and the expression of MMP-1, -2 ,-9, TIMP-1 and -2 in the lung tissue was measured by immunohistochemistry. Thirty five patients, who were diagnosed with IIP (UIP ; 22, NSIP ; 13), were enrolled in the immunohistochemical study. Thirteen patients with IIP (UIP ; 9, NSIP ; 4) and five patients with lung cancer were enrolled in the zymographic assay. RESULTS: (1) The immunohistochemistry for MMP-1,-2,-9, TIMP-1 and-2 ; MMP-1,-9 and TIMP-2 were stained stronger in the UIP subjects than NSIP and the normal control. TIMP-2 was strongly stained in the UIP tissue. particularly the fibroblasts in the fibroblastic foci. (2) Zymography for MMP-2 and MMP-9 revealed MMP-2 to have prominent expression in the UIP tissue than in the NSIP tissue. CONCLUSIONS: These results suggest that the overexpression of the TIMPs and gelatinases in UIP might be? important factors in the irreversible fibrosis of the lung parenchyme.

A Huge Congenital Sinus of Valsalva Aneurysm Causing Cerebral Embolism and Hypoplastic Tricuspid Valve

Congenital sinus of Valsalva (SOV) aneurysm is a rare cardiac abnormality. Rarely the aneurysm enlarges without rupture, cause symptoms of the mass effect by compressing the adjacent structures, obstruction of the right ventricular outflow with tricuspid regurgitation, infectious endocarditis, thrombus formation and myocardial ischemia/infarction. And SOV aneurysm can also be a source of embolism. We observed a patient with cerebral infarction in whom a huge SOV aneurysm, was diagnosed as the presumed source of cerebral embolism and the cause of hypoplastic tricuspid valve.

A Case of Huge Ascending Aortic Aneurysm with Wall Calcification

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.

Henoch-Schonlein Purpura associated with Adenocarcinomas in Stomach and Colon / 대한신장학회잡지

There are a few reports about coexistence of Henoch-Schonlein purpura (HSP) and a variety of malignancy in adults. The accompanying malignancies, in order of frequency, were hematologic malignancy, lung cancer and prostate cancer. Gastrointestinal tract (GIT) cancer associated with HSP was rarely reported which includes 2 cases of stomach cancer, 1 case of small bowel cancer and 1 case of esophageal cancer. Malignancy is proposed to be a triggering factor in the development of HSP, however pathogenesis of HSP associated with malignancy remains obscure. Here, we report 2 cases of HSP associated with malignancy in GIT. One is an adenocarcinoma of the colon and the other is a stomach adenocarcinoma with signet ring cell component.

Amebiasis in children in the City of Manila with a report of 41 cases

1. An alarm has been sounded regarding the greatly increased incidence of amebic dysentery in children of Manila during the last year2. This report presents 41 such cases3. Symptoms presented by cases studied are familiar and more or less typical of textbook descriptions4. No definite conclusions can be made regarding therapy instituted. (Summary)

Syphilis in children in the Philippines - its incidence and treatment

1. Although no sweeping conclusions can be made, it appears that, clinically, penicillin has a dramatic and evidence effect on syphilis in children and a quicker tendency to serological reversal2. No toxic reactions have been observed3. For the present, ten thousand units of penicillin given every three hours around the clock by intramascular injection for a total of sixty injections and for a period of 7 1/2 days is sufficient to produce at least a clinical cure4. The number of cases syphilis admitted in the pediatric ward of the Philippine General Hospital is increasing. There having been more cases (53%) in the year just ended than in any one previous year since 1939. (Conclusions)

Bilateral cataract extraction in one sitting

A total of 60 unselected charity patients with bilateral senile cataracts were operated on at one sittingThirty-six of these were females, and 24 were males, their ages ranging from 38 to 84 yearsOf these 60 cases, intracapsular deliveries on both sides were possible in 39 patients, extracapsular deliveries on both sides in three patients, and one intracapsular and the other extracapsular in 18 patientsAlthough 67 of these 120 eyes were delivered by capsule forceps, 47 eyes were still delivered by Indian Smith. Recent and future operations, however, employ more the use of capsule forcepsThere were six cases of vitreous prolapse. It may be inferred that, for practical purposes, all of these could have happened even if unilateral extractions were done. This was true with hemorrhage and collapse of the anterior chamber. There was only one case of aphakic glaucomaMuch time and money can be saved by doing bilateral cataract extraction at one sittingThe visual results, though far from ideal, are quite satisfactory. (Summary and Conclusion)