Extranodal nasal-type natural killer/T-cell lymphoma with nasal septal perforation.

There are very few reports of extranodal nasal-type NKTL with septal perforation, as seen in our patient. In addition, extranodal nasal-type NKTL is often diagnosed as chronic inflammation on histopathological examination. Therefore, if nasal septal perforation does not improve with appropriate conservative treatment, clinicians should consider a malignant disease such as extranodal nasal-type NKTL.

Positional changes in the uvula tip after adenotonsillectomy in children: preliminary result.

BACKGROUND: Adenotonsillectomy has become the primary treatment for children with sleep-disordered breathing or obstructive sleep apnea. However, few studies have investigated positional changes in the soft palate or uvula after adenotonsillectomy in children. The present study aimed to evaluate positional changes in the uvula tip using cephalometric analyses after adenotonsillectomy in children. METHODS: We analyzed 160 pediatric patients from December 2015 to July 2016, with 94 pediatric patients who underwent adenotonsillectomy as the experimental group and 66 children who were treated and followed up with frequent tonsillitis as the control group. Positional changes in the uvula tip after surgery in the adenotonsillectomy group were investigated using lateral cephalograms obtained within 1 month before surgery and 3-4 months after surgery. Two lateral cephalogram intervals for a few months in the control group who did not undergo adenotonsillectomy were analyzed. RESULTS: The palatal length (23.92 ± 3.47 vs. 24.46 ± 3.26; p = 0.032), palatal angle (43.13 ± 7.76 vs. 46.12 ± 5.91; p < 0.001), and retrouvula length (15.60 ± 3.51 vs. 16.60 ± 2.97; p = 0.009) were significantly increased on postoperative images relative to those on preoperative images. In the control group, there was a significant change in the palatal angle (2.99 ± 5.85 vs. 0.27 ± 4.14; p < 0.001) and retrouvula length (0.99 ± 3.64 vs. 0.05 ± 1.44; p = 0.025), but not in the palatal length (0.58 ± 2.38 vs. 0.043 ± 1.26; p = 0.065). CONCLUSION: The findings of the present study suggest that the uvula tip is displaced in the anteroinferior direction 3 or 4 months after adenotonsillectomy in children. Thus, clinicians should be aware that the retropalatal space may expand after adenotonsillectomy in the pediatric population.

Number of seasonal exposures to Japanese cedar pollen increases the risk of sensitization: Observational study in Korean adults.

Sensitization to seasonal allergens usually requires repeated exposure to them. However, research on the extent of exposure that increases the risk of sensitization to specific allergens is lacking. Therefore, we investigated the levels of exposure to Japanese cedar pollen that increased the risk of sensitization to it. A cross-sectional study was conducted with 857 college students living in Jeju, South Korea, as it is the only province in Korea where Japanese cedar pollen levels are high. Questionnaires about demographic characteristics were distributed and skin prick tests for allergic sensitization were performed. Sensitization rates of groups divided by residence period were 3.8% (less than 1 year), 1.8% (1-2 years), 8.5% (2-3 years), 10.3% (3-4 years), 14.8% (4-10 years), and 19.1% (over 10 years). Residence period was an influencing factor of sensitization rate to Japanese cedar pollen, and the cut-off value of the residence period that increased the risk of sensitization to Japanese cedar pollen was found to be 25 months. Repeated exposure to seasonal allergens was related to an increased sensitization rate in young adults. Our results suggested that exposure to Japanese cedar pollen for over two seasons could increase the risk in Korean adults.

Computed Tomography Findings in Patients with Samter's Triad: An Observational Study.

Samter's Triad is a disorder characterized by chronic rhinosinusitis (CRS) with nasal polyps (NPs), asthma, and intolerance to cyclooxygenase-1 inhibitors. However, there have been no studies investigating the prediction of Samter's Triad using imaging findings. Therefore, the authors aimed to investigate whether there is a difference in computed tomography (CT) findings between patients who have CRS with NPs and those with Samter's Triad. Patients were classified into a CRS group and a Samter group. Opacification was measured using data from CT scans by scoring each sinus on a numerical rating scale ranging from 0 to 4. The opacification scores of the ethmoid and frontal sinuses were significantly higher in the Samter's Triad group. Furthermore, Samter's Triad was more common in patients who scored ≤ 2 for maxillary opacification (7/16) than in those who scored ≥3 (4/45, p=0.005). Patients with Samter's Triad exhibited a tendency toward higher opacification scores for the ethmoid and frontal sinuses, with a relatively lower opacification score for the maxillary sinus. These findings could be helpful in distinguishing patients with Samter's Triad from those who have CRS with NPs, and to plan treatment strategies without having to perform additional laboratory or radiological tests.

Chronological changes in rhinitis symptoms present in school-aged children with allergic sensitization.

INTRODUCTION: It is difficult to accurately predict the natural course of allergic rhinitis (AR), because it is affected by a wide variety of environmental influences, as well as genetic predisposition. Considering the high prevalence of allergic rhinitis in children and adolescents, caregivers should be given appropriate information regarding the disease course. This study aimed to understand the prognosis of allergic rhinitis by examining the relationship between allergic sensitization and rhinitis symptoms during this developmental period. METHODS: This cross-sectional study included 1069 children aged 9-16 years from the Korean International Study of Asthma and Allergies in Childhood Survey database who had completed health questionnaires, and for whom skin prick test results were available. Data were collected during May 2016. The distribution of sensitization and allergic symptoms was compared by age groups (elementary, middle, and high school). Data were analyzed using linear-by-linear analysis. RESULTS: Sensitization to at least one tested allergen differed by age (59.2%, 58.3%, 68.2%, in elementary, middle, and high school students, respectively; p = 0.025), and seasonal allergen sensitization (35.0%, 37.1%, 53.9%, respectively) increased with age (p < 0.001). Conversely, the proportion of rhinitis symptoms among sensitized children decreased as age increased (58.80%, 52.90%, 49.70%, respectively; p = 0.047). However, the rate of non-allergic rhinitis was age-independent. CONCLUSION: With increasing age during childhood and adolescence, symptomatic allergic rhinitis decreases; thus, subclinical allergic rhinitis increases. This suggests that the symptoms of later-sensitized children are less clearly manifested, or that the symptoms reduce as previously sensitized children mature. This should be clarified further in a longitudinal study.

Is high sodium intake associated with hearing impairment? The association between spot urine sodium concentration and hearing threshold in Korean adolescents.

BACKGROUND AND OBJECTIVES: High sodium intake is a well-known risk factor for diseases such as cardiovascular and renal disease. There may also be links between sodium intake and inner ear symptoms. However, the available data are limited, and clinicians remain suspicious about sodium intake and hearing threshold. We analyzed the relationship between spot urine sodium concentration and sensorineural hearing loss in Korean adolescents. METHODS AND STUDY DESIGN: A total of 534 subjects, aged 12-19 years old, were enrolled in this study. Sex, age, hearing threshold, and overnight spot urine sodium concentration were measured. Multivariate logistic regression analysis was performed to estimate the independent effect of sodium intake on hearing level. RESULTS: Higher urine sodium concentrations were observed in subjects with hearing impairment in 2000, 3000 and 4000 Hz. After adjusting for sex, age and BMI, we found an association between urine sodium concentration and sensorineural hearing loss in 500, 2000, 3000 and 4000 Hz. CONCLUSION: Our results suggest that high sodium intake might be associated with hearing impairment.

Relationship between various anthropometric measures and apnea-hypopnea index in Korean men.

OBJECTIVE: Body mass index (BMI) has been shown to be strongly correlated with severity of OSA. However, BMI has not been shown to be correlated with sleep apnea in all patients studied. The purpose of this study was to evaluate the relationship between various anthropometric measures and severity of OSA according to BMI in men. METHODS: We conducted a retrospective analysis of the medical records of patients who visited for evaluation of OSA. Polysomnography results, height, weight, neck circumference, waist circumference, and hip circumference were obtained in all subjects. BMI, body adiposity index, waist to hip ratio, and waist to height ratio were also calculated. RESULTS: A total of 195 male participants were included in the final analysis. BMI showed the strongest correlation with AHI in all subjects. In 125 participants with a BMI of 25 or more, BMI was most strongly correlated with high AHI compared to other measurements. However, waist to hip ratio showed the strongest correlation with AHI in 70 participants with a BMI of less than 25 and, in this group, BMI did not show significant correlation with AHI. CONCLUSION: Considerations about anthropometric measurements in OSA patients should differ according to degree of obesity or BMI.

The association between the parenting stress of the mother and the incidence of allergic rhinitis in their children.

OBJECTIVES: The prevalence of allergic rhinitis and the social burden related to the management of allergic rhinitis have persistently increased. There are many studies investigating the association between the allergic diseases of children and the stress of their parent. However, the relationship between parenting stress and the incidence of allergic rhinitis among children requires further investigation. We aimed to investigate the significance of parenting stress for mothers with children treated for allergic rhinitis. METHODS: The mothers of 250 children in the second and third grade of elementary school were involved in this study. The Parenting Stress Index-Short Form (PSI-SF) was used to measure parenting stress. Additionally, the monthly household income, treatment history for allergic diseases (atopic dermatitis, asthma, and allergic rhinitis) during the past 12 months, and maternal education status were investigated using the questionnaire. RESULTS: Parenting stress index score was significantly higher among the mothers of children treated for allergic rhinitis (76.41 ± 9.35) compared with the parents of children without treatment history for allergic rhinitis (70.06 ± 13.74). Nonetheless, there were no significant differences between the cases of children with atopic dermatitis and those with asthma. We analyzed the association between allergic rhinitis and parenting stress adjusted for the monthly household income, and maternal education status, and showed that a treatment history of allergic rhinitis was significantly associated with parenting stress (coefficient 7.477, 95% interval 1.703-13.252; p = 0.011). CONCLUSION: Treatment of the children for allergic rhinitis significantly affects the parenting stress of their mother. We recommend that mothers with children with allergic rhinitis should receive appropriate counseling about parenting stress.

Mucosal Melanoma Originating From the Eustachian Tube.

A 77-year-old man was referred with a 4-month history of hearing impairment and ear fullness of the left ear. Otoscopic examination revealed an effusion in the left middle ear, and nasal endoscopic examination revealed a dark polypoid lesion at the opening of the left Eustachian tube. In addition to the lesion of the Eustachian tube, a dark mucosal lesion was seen at the posterior choana and the posterior end of the nasal septum. Endoscopic biopsy was done and pathologic result was consistent with malignant melanoma. Wide surgical excision with postoperative radiotherapy was performed; multiple metastases were detected 4 months after the treatment. Mucosal melanoma originating from nasopharynx was extremely rare, but careful examination of nasopharyngeal area should be considered when the patient presents with unilateral middle ear effusion, especially in older age.

The role of adjuvant external beam radiation therapy for papillary thyroid carcinoma invading the trachea.

PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26-87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.

Prevalence of Pseudoexfoliation Syndrome in an Isolated Island Population of Korea: The Woodo Study.

PURPOSE: To determine the prevalence and clinical characteristics of pseudoexfoliation syndrome (PXS) within Korean population living in Woodo Island. METHODS: Among the 625 residents aged 50 years or older, 305 residents (197 women and 108 men) participated in the study; a response rate of 48.8%. Participants filled out questionnaires on life style. Intraocular pressure and corneal endothelial cell function was measured. Both pupils were dilated. Fundus photographs and stereo disc photographs were taken. Vertical cup-to-disc ratio was determined. Pure tone audiometry threshold was measured at 0.5, 1, 2, 4, and 6 kHz of frequencies for each ear. RESULTS: The prevalence rate of PXS among Woodo Island residents older than 50 years significantly increased with age, from 1.0% [95% confidence interval (CI), 0%-2.8%] in participants aged 50 to 59 years to 23.3% (95% CI, 8.2%-38.5%) in those aged over 80 years (P<0.001). The prevalence of PXS showed no significant difference between men and women in all age groups. The age-standardized prevalence rate of PXS was 10.4% (95% CI, 8.0%-12.8%), with a rate of 9.4% (95% CI, 5.8%-13.1%) in men and 14.9% (95% CI, 11.3%-18.4%) in women. PXS did not show significant association with smoking, outdoor activity, and occupation, except alcohol consumption. PXS showed significant decrease in endothelial cell density. Pure tone audiometry test of PXS group revealed statistically significant decrease in 1, 2 kHz. CONCLUSIONS: The prevalence of PXS was 10.4% in the 50 years and older age group, and tended to increase with age. Decrease in corneal endothelial function and selective hearing loss was correlated in PXE patients, supporting impairment of systemic endothelial function in PXE syndrome.

Sialolithiasis of an Accessory Parotid Gland Causing Mid-Cheek Pain.

A 52-year-old woman presented with a slightly painful swelling of the right cheek area without postprandial aggravation of the symptom last 1 week. On physical examination, an approximately 1.5 cm sized firm, slightly tender mass was palpated on the right mid-cheek region, and she did not show any abnormal findings on neurologic examination. Computed tomography showed a well-enhanced lesion with low density of internal portion in right cheek area, and tiny calcification was noted within internal low-density portion of cheek mass. These findings suggested sialolithiasis of an accessory parotid gland with duct dilatation. Mid-cheek pain with conservative medical treatment was resolved and has not occurred during 1 year follow-up.

Serum periostin level is not associated with allergic rhinitis or allergic sensitization in Korean children.

OBJECTIVES: Periostin is a matricellular protein, synthesized in the airway epithelium and induced by interleukin (IL)-4 and IL-13. The significance of periostin as a biomarker of T helper type 2 cell (Th2)-induced airway inflammation, and as a measure of the response to Th2-targeted therapy, has recently been highlighted. We explored the relationship between serum periostin and allergic rhinitis in Korean children. METHODS: Data for fifth and sixth grade children from six randomly selected elementary schools located in Jeju and Seogwipo City, Korea, were investigated. Serum periostin levels were determined by enzyme-linked immunosorbent assay. Sex, school grade, body mass index, and presence of allergic nasal symptoms were obtained via a self-reported survey and skin prick testing was performed. RESULTS: There were no significant differences between groups, when stratification was applied according to sex, grade, presence of atopy, and presence of allergic nasal symptoms. Sex and body mass index were significantly associated with serum periostin levels in multivariate linear regression analysis. However, allergic rhinitis was not associated with serum periostin levels. CONCLUSION: Allergic rhinitis or allergic sensitization in Korean children did not influence serum periostin levels. Further studies are required to investigate the significance of serum periostin levels in pediatric allergic rhinitis.

An object localization optimization technique in medical images using plant growth simulation algorithm.

The analysis of leukocyte images has drawn interest from fields of both medicine and computer vision for quite some time where different techniques have been applied to automate the process of manual analysis and classification of such images. Manual analysis of blood samples to identify leukocytes is time-consuming and susceptible to error due to the different morphological features of the cells. In this article, the nature-inspired plant growth simulation algorithm has been applied to optimize the image processing technique of object localization of medical images of leukocytes. This paper presents a random bionic algorithm for the automated detection of white blood cells embedded in cluttered smear and stained images of blood samples that uses a fitness function that matches the resemblances of the generated candidate solution to an actual leukocyte. The set of candidate solutions evolves via successive iterations as the proposed algorithm proceeds, guaranteeing their fit with the actual leukocytes outlined in the edge map of the image. The higher precision and sensitivity of the proposed scheme from the existing methods is validated with the experimental results of blood cell images. The proposed method reduces the feasible sets of growth points in each iteration, thereby reducing the required run time of load flow, objective function evaluation, thus reaching the goal state in minimum time and within the desired constraints.