Respiratory Muscle Strength in Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE: To compare the respiratory muscle strength between patients with stable and acutely exacerbated (AE) chronic obstructive pulmonary disease (COPD) at various stages. METHODS: A retrospective medical record review was conducted on patients with COPD from March 2014 to May 2016. Patients were subdivided into COPD stages 1–4 according to the Global Initiative for Chronic Obstructive Lung Disease guidelines: mild, moderate, severe, and very severe. A rehabilitation physician reviewed their medical records and initial assessment, including spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), COPD Assessment Test, and modified Medical Research Council scale. We then compared the initial parameters in patients with a stable condition and those at AE status. RESULTS: The AE group (n=94) had significantly lower MIP (AE, 55.93±20.57; stable, 67.88±24.96; p=0.006) and MIP% (AE, 82.82±27.92; stable, 96.64±30.46; p=0.015) than the stable patient group (n=36). MIP, but not MEP, was proportional to disease severity in patients with AE and stable COPD. CONCLUSION: The strength of the inspiratory muscles may better reflect severity of disease when compared to that of expiratory muscles.

Joubert Syndrome Presenting With Normal Pyramidal Decussation: A Case Report

Joubert syndrome (JS) is a rare genetic disorder characterized by a congenital malformation of the hindbrain, and accompanied by axonal decussation abnormalities affecting the corticospinal tract and the superior cerebellar peduncles. To the best of our knowledge, there are no reports of normal pyramidal decussation in JS. Here, we describe the case of an 18-year-old boy presenting midline-crossing corticospinal projections, which were considered normal corticospinal tract trajectories. Diffusion tensor imaging and motor evoked potential study analysis demonstrated the exclusive presence of decussating corticospinal projections in the patient. Based on these results, we suggest that JS might be associated with several, diverse corticospinal motor tract organization patterns.

A Case of Invasive Fungal Sinusitis after Kidney Transplantation / 대한신장학회지

Acute fulminant invasive fungal sinusitis in an immunocompromised host and bacterial rhinosinusitis with intracranial or orbital extension is challenging to manage. And it sometimes constitutes true otolaryngologic emergencies. In the absence of rapid diagnosis and treatment, these diseases can be fatal. A 57-year-old female was admitted for chills and headache, who received a deceased donor renal transplantation 3 months ago. Paranasal sinus CT showed enhanced soft tissue density and MRI showed low-signal with hyperintense signal of around paranasal sinus cavity. The histological investigation revealed invasive aspergillosis of paranasal sinuses. Clinical improvement occurred after endoscopic sinus surgery and post-operative systemic antifungal therapy with amphotericin B and voriconazole.

A case of Dubin-Johnson syndrome with a pigmented neurofibroma / 대한내과학회지

Clinically, Dubin-Johnson syndrome is characterized by mild icterus without specific symptoms or signs. The icterus is so mild that it is usually noted only during another illness, pregnancy, or the use of oral contraceptives. There is no pruritus in ubin-Johnson syndrome. The physical examination is usually normal, except for the icterus, although hepatosplenomegaly is seen occasionally. Histologically, the liver is normal, except for the presence of dense pigment making it appear black grossly. Pigmentation of tissues other than the liver in patients with Dubin-Johnson syndrome has been reported only in a few cases. We experienced a case of Dubin-Johnson syndrome with extrahepatic pigmentation in the skin with a neurofibroma in a 66-year-old man.

A Case of Fibro-Osseous Hamartoma Originated from Nasal Cavity / 대한이비인후과학회지

Hamartoma occurs in all areas of the body, especially in the liver, spleen, kidney and lung. However, it was rarely reported in the nasal cavity, paranasal sinuses, or nasopharynx. The histopathological and clinical differential diagnosis of fibro-osseous hamartoma of the sinonasal tract includes ossifying fibroma, fibrous dysplasia and osteoma. We present the case of a 57-year-old man with nasal obstruction in right side, which was treated with complete resection by endoscopic approach. A combination of clinical, radiographic and histological information permitted a diagnosis of a benign fibro-osseous hamartoma in this case.

A Case of a Gastric Metastasis of a Renal Cell Carcinoma / 대한소화기내시경학회지

A gastric metastasis is an extremely rare event accounting for 0.2 to 0.7% of gastric neoplasms seen at necropsy. Primary origins of a gastric metastasis are pancreatic cancers, colon cancers, lung cancers and malignant melanomas. A renal cell carcinoma is renowned for its metastatic potential to spread to almost any organ of the body. However, a gastric metastasis of a renal cell carcinoma is very rare. It is believed that a renal cell carcinoma metastasizes hematogenously and it spreads through a renal vein to the stomach via the inferior vena cava and hemiazygos vein. A metastasis to the stomach is frequently located in the greater curvature of body. Endoscopic findings of a gastric metastasis often resemble a submucosal tumor with or without ulcer. Presenting symptoms are bleeding, anemia, or pyloric obstruction, but often the patient is asymptomatic. We report a case and review of the literature of a metastatic renal cell carcinoma to the stomach in a 71-year-old man who complained of a palpable abdominal mass.

Comparison of heart rate variability between end stage renal disease patients on hemodialysis and hypertensive patients / 대한내과학회지

BACKGROUND/AIMS: Heart rate variability (HRV) can be used to assess the effects of drugs and other interventions, including exercise, respiration, metabolic changes, and psychological or physical stressors, on cardiac autonomic tone. HRV is regulated by the balance of sympathetic and parasympathetic tone. Few studies pertaining to HRV in end stage renal disease (ESRD) patients have been performed in Korea. Thus, autonomic nervous system activity as indicated by HRV was investigated in patients on hemodialysis due to ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through time- and frequency- domain analyses of HRV with 24-hour Holter monitoring in 30 ESRD patients and 64 hypertensive control subjects. The ESRD patients had undergone hemodialysis therapy at the Bongseng Hospital between January 2006 and June 2007. RESULTS: The mean age of ESRD patients and hypertensive controls was 51.17+/-11.91 and 55.02+/-13.72 years, respectively. In the ESRD group, all time- and frequency-domain HRV measures, including the standard deviation of all normal sinus R-R intervals over 24 hours (SDNN), the HRV index, the very low-frequency (VLF) normalized unit of low-frequency (LFnorm), and the ratio of low-frequency power to high-frequency power (LF/HF), were reduced; the normalized unit of high frequency (HFnorm) was increased in the ESRD patients compared with the control group. CONCLUSION: The autonomic tone in ESRD patients on hemodiaysis was decreased compared with hypertensive patients. The parasympathetic tone in ESRD patients on hemodyalysis was dominant over the sympathetic tone.

A Safety and Effectiveness of High Pressure Balloon Dilatation for Sirolimus-Eluting Stent Implantation in the Ischemic Heart Disease

BACKGROUND: We have no information about the safety and effectiveness when we perform overdilating a sirolimuseluting stent(SES) with high pressure. In some specific animal model, the study reported overdilatation of SES with high pressure resulted in increase of restenosis. The aim of this study was to evaluate the safety and effectiveness of overdilatation of SES with high pressure. METHODS: 97 patients underwent PCI using SES between August 2003 and July 2005 were divided into two group(high pressure group, low pressure group), stents were implanted with high pressure(>18 atm) and low pressure(<12 atm). We compared between the two group of safety of stents, major adverse cardiac events(MACE), rate of restenosis, late loss. RESULTS: In high pressure group, there are more type C lesion(51% vs 38%, p<0.01). There were no significant differences between the two groups regarding MACE(12.8% vs 17.2%, p=0.78), in-stent restenosis rate(2.6 % vs 5.2%, p=0.65). There are small increasing of late loss in high pressure group, but no statistically significant difference(0.30 vs 0.15, p=0.05). CONCLUSION: Implantation of SES overdilated with high pressure is able to be performed safely to obtain wider inner lumen of stents.

A Case of a Primary Esophageal Bezoar after a Total Gastrectomy / 대한소화기내시경학회지

An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications.

A Case of Ethmoidal Sarcoidosis / 대한이비인후과학회지

Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown etiology. Most commonly, it involves the lung parenchyme and hilar lymph nodes. Head and neck involvement is found in 9% of the patients, with sinonasal involvement demonstrated only in 1% of these patients. Diagnosis is usually performed according to the clinical, laboratory, radiographic and histological features and by excluding other granulomatous diseases. Of these features, the histologic finding is a major diagnostic tool. In sinonasal sarcoidosis, the most common symptoms are nasal obstruction and crusting, and the most consistent finding was an edematous, friable, erythematous and hypertrophied mucosa. The clinical course is variable and there is no consensus about the treatment options. But, the systemic corticosteroid is the mainstay of treatment. We report a case of ethmoidal sarcoidosis which was successfully managed by endoscopic sinus surgery along with systemic corticosteroid. To our knowledge, this is the first report of sinonasal sarcoidosis in Korea.

A Case of Olfactory Neuroblastoma in Sphenoid Sinus / 대한이비인후과학회지

Olfactory neuroblastoma is a relatively uncommon malignant tumor originating from neuroectoderm and it usually arises from the superior portion of the nasal cavity, such as superior turbinate, superior part of septum, or cribriform plate. Cases of olfactory neuroblastoma from sphenoid sinus, in which olfactory epithelium rarely exists, have been rarely reported. Although nasal obstruction and epistaxis are the most common presenting symptoms of olfatory neroblastoma, our patient presented with headache and dizziness. The most common cause of isolated sphenoid lesion is inflammation, but the possibility of tumorous conditions should not be excluded without thorough evaluation. The authors experienced a rare case of olfactory neuroblastoma from sphenoid sinus that had been confused as isolated sphenoid sinusitis. So we report our unusual case with a brief review of literature.

Primary Squamous Cell Carcinoma of the Endometrium / 대한산부인과학회잡지

Primary endometrial squamous cell carcinoma is extremely rare, with only 64 cases reported in the literature. In 1928 Fluhmann proposed three criteria for differentiating primary from secondary endometrial squamous cell carcinoma: (1) no coexisting endometrial adenocarcinoma (2) no connection between the endometrial tumor and the squamous epithelium of the cervix, and (3) no squamous cell carcinoma of the cervix present. Several authors have modified these criteria in their case presentations. Kay accepts the presence of an in situ cervical carcinoma, if there is no connection between cervical carcinoma in situ and the endometrial tumors. We have experienced a case of simultaneous carcinoma in situ of the cervix and endometrial squamous cell careinoma. This case was treated with chemotherapy(cisplatin, 5-fluoruracil) and external radiation following extended hysterectomy and bilateral salpingooophorectomy We report this case with a review of the concerned literatures.

A Case of Ectrodactyly Fetus / 대한산부인과학회잡지

Split hand split foot(SHSF) is a rare human developmental defect characterized by mi-ssing digits, fusion of remaining digits, and a deep median cleft in the hands and feet. Cy-togenetic studies of deletions and translocations associated with this disorder have indicated that an autosomal dominant split hand/split foot locus maps to 7q21-q22. We have experienced a case of ectrodactyly in a 25-year-old primigravida woman and her baby and reported out our experience with a review of related literature.

A Clinical Study on Cesarean Hysterectomy / 대한산부인과학회잡지

This study analyzed the outcome of 26 cases of cesarean hysterectomy performed at Wonju Christian Hospital, College of medicine, Yonsei university during 15 years from January, 1982 to May, 1996. There were 27,602 deliveries during this period. Cesarean hysterectomy was performed in 11 of 10,373 cesarean section(0.11 %) and in 15 of 17,229 vaginal deliveries(0.09 %). The age of patients varied from 20 to 48. Indications for emergency cesarean hysterectomy were uterine atony (46.2 %), uterine rupture(26.9 %), and placenta accreta(19.2 %). The relative risk of emergency hysterectomy was 1.22(95 % confidence interval 0.56 to 2.65) for cesarean deliveries, 1.91(95 % confidence interval 0.73 to 4.98) for prior cesarean deliveries and 20.56(95 % confidence interval 10.85 to 38.95) for placenta previa. The patients who had cesarean hysterectomy received from 750 ml to 11,500 ml of blood transfusion with a mean of 3,500 ml. No significant differences in length of operating time, amount of blood loss and postoperative complications were found between total abdominal hysterectomy and subtotal abdominal hysterectomy. In about 1/2 of total patients (46.2 %), there were no operative complications. Maternal death was found in 1 case. Hemorrhage still remains main cause of maternal mortality, the decision of hysterectomy must be conjunction with maternal life saving and free from various dangerous sequalae. So in this study, clinical evaluation for cesarean hysterectomy and an attempt to identify risk factor that might pridict those patients likely to require emergency hysterectomy was made.