Comparison of Autophagy mRNA Expression between Chronic Otitis Media With and Without Cholesteatoma

Background and Objectives@#Autophagy is known to be associated with pathogen infection. However, the expression of autophagy-related proteins has not been studied in chronic otitis media without cholesteatoma (COM) or with cholesteatoma (CholeOM). This study aimed to determine whether there is a difference between COM and CholeOM in autophagy-related gene mRNA expression. @*Subjects and Methods@#For 47 patients with chronic otitis media, the inflammatory tissues were classified into granulation tissue (COM) or cholesteatoma (CholeOM) according to biopsy results. @*Results@#PI3K mRNA expression (COM vs. CholeOM, mean±SD, 0.009±0.010 vs. 0.003±0.004; p=0.004) was lower, whereas Beclin-1 mRNA expression (0.089±0.107 vs. 0.176±0.163; p=0.034) was higher in the CholeOM group. Expression of PI3K mRNA in the CholeOM group was lower than that in the COM subgroups with presence of bacteria (0.022±0.019 vs. 0.001±0.001; p=0.001), otorrhea (0.049±0.068 vs. 0.003±0.004; p=0.004), and hearing loss over 40 dB (0.083±0.130 vs. 0.003±0.004; p=0.005). @*Conclusions@#The data suggested that different autophagy proteins play important roles in chronic otitis media according to the presence or absence of cholesteatoma.

Association Between High Neutrophil to Lymphocyte Ratio and Delayed Recovery From Bell's Palsy

OBJECTIVES: Factors predictive of the severity of and recovery from Bell's palsy remain unclear. This study evaluated the association between neutrophil to lymphocyte ratio (NLR) and the severity of and recovery from Bell's palsy. METHODS: This retrospective study included 51 patients who were hospitalized with Bell's palsy from 2015 to 2017. Degree of paralysis was assessed by House-Brackmann (H-B) grade. Patients with H-B grades 2–4 were classified as having mild to moderate palsy and patients with H-B grade 5 or 6 were classified as having severe palsy. Patients were evaluated for obesity, hypertension and diabetes mellitus, and blood tests were performed to determine NLR and platelet to lymphocyte ratio. Patients were treated with steroids and antiviral agents. H-B grade was assessed 1 week, 1 month, and 3 months after treatment. RESULTS: NLR was significantly higher in patients with severe than with mild to moderate palsy (P=0.048). Recovery time was significantly longer in patients with high NLR than low NLR (P=0.045). CONCLUSION: Higher NLR in patients with Bell's palsy was associated with longer recovery time. NLR may be prognostic of recovery time in patients with Bell's palsy.

Decreased Aquaporin 4 and 6 mRNAs in Patients With Chronic Otitis Media With Otorrhea

OBJECTIVES: Aquaporins (AQPs) are integral membrane proteins engaged in the modulation of water homeostasis, but the roles they play in chronic otitis media (COM) have not been well investigated. Accordingly, we undertook document relations between the mRNA expressions of AQPs and COM, and explored the relation between these expressions and otorrhea, which is one of the most common symptoms of COM. METHODS: Levels of the mRNAs of AQP 1, 2, 3, 4, 5, 6, 8, and 10 were assayed by real-time polymerase chain reaction in inflammatory tissue samples from 81 patients with COM with or without otorrhea. Relationships between AQP mRNA levels and the presence or absence of otorrhea, the presence or absence of bacteria, hearing threshold levels, types of hearing loss, and clinical manifestations were also evaluated. RESULTS: AQP 1, 2, 3, 4, 5, 6, 8, and 10 mRNAs were expressed in inflammatory tissues obtained from all 81 patients with COM with or without otorrhea. AQP 5 mRNA was most expressed in, followed in descending order by AQP 3, 1, 10, 6, 8, 2, and 4. There were no significant intergroup differences in terms of age, sex, duration of illness, levels of hearing loss in both ears, or incidences of conductive or sensorineural hearing loss. However, AQP 4 (P=0.035) and 6 (P=0.085) mRNA levels were significantly lower in the otorrhea group. In addition, bacteria culture positivity (P=0.014) and the incidence of sensorineural hearing loss (P=0.020) were higher in the otorrhea group. CONCLUSION: AQP 1, 2, 3, 4, 5, 6, 8, and 10 are involved in the development of COM. Specifically, it shows reductions in AQP 4 and 6 mRNA levels, as observed in the otorrhea group, have an effect on the clinical manifestations of COM.

The Association of Patient-Reported Local Allergic Symptoms with Postoperative Outcomes of Chronic Rhinosinusitis

A Nasal Myoepithelioma Removed through Preoperative Embolization and Endoscopic Surgery: A Case Report and Literature Review / 대한이비인후과학회지

Myoepithelioma is a rare benign tumor, most frequently located in the salivary gland. However, involvement of an extra-salivary gland is even rarer and very few cases involving the nasal cavity have been reported in the literature. A 51-year-old female patient presented with a complaint of progressive nasal obstruction and occurrence of recurrent epistaxis in the left nasal cavity over several months. A hemorrhagic and erythematous mass occupying the left nasal cavity was observed on physical examination using a nasal endoscope. A preoperative angiogram confirmed that he tumor was receiving blood supply from the sphenopalatine artery. We performed embolization to prevent hemorrhage during surgery; one day later, the lesion was successfully removed through endoscopic excision. Histopathological examination revealed that the tumor contained myoepithelial cells and myxoid stroma. Immunohistochemical studies showed that the tumor was positive for cytokeratin marker and S-100 protein, confirming the diagnosis of myoepithelioma. The patient recovered without any nasal symptoms or postoperative deficits.

Psychological Characteristics and Aesthetic Concerns of Male Patients Seeking Primary Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The demand for rhinoplasty has been high for both men and women over the years; recently, however, it is rapidly increasing for men as their interest in aesthetics has heightened. This study investigated the psychological characteristics of male patients who underwent rhinoplasty through questionnaire-guided consultation. In addition, we investigated the difference between patients and surgeons regarding their aesthetic concerns for rhinoplasty. SUBJECTS AND METHOD: Of the male patients who underwent rhinoplasty from January 2006 to December 2012, 124 patients who had completed the questionnaires were included. The questionnaire for rhinoplasty asked about the basic personality traits of patients, patients' complaints about their nose, reasons for receiving the operation and expectation for postoperative change. RESULTS: Patients responded most to the item, “I have high expectations for the surgery” for the question regarding personality characteristics, followed by the response, “I am concerned about my health.” Regarding questions about reasons for rhinoplasty, complaints about their dorsum were high; among these patients, they were most concerned about the appearance of the ‘crooked nose’ when viewed from the front. On the other hand, the concern for the ‘poorly defined nasal tip’ was not high, whereas it was defined as one of the problems mentioned by the surgeons. CONCLUSION: These results show differences regarding aesthetic concerns between the patients and the surgeon, especially regarding the nasal tip. It would be helpful for both patient and surgen to plan the surgery after careful consultation based on the questionnaire, accurate understanding of the patients' complaints and expectations to obtain satisfactory results for both.

Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.

Difference according to Interpretation Methods in Allergic Skin Test

BACKGROUND AND OBJECTIVES: The skin prick test is a widely used test that uses three methods (allergen/histamine ratio method, erythema size method, and wheal size method) to interpret the results. However, there has been no comparison of these methods. The aim of this study is to compare the three different interpretation methods and define the relationship among them. SUBJECTS AND METHOD: A total of 139 patients who visited our allergy clinic complaining of nasal symptoms were enrolled. Three interpretation methods were used for defining positivity in the skin prick test, and their results were compared. The validity of each interpretation method was evaluated by total nasal symptom score. RESULTS: Positivity in the skin prick test was reported in 48.2% of patients according to the allergen/histamine ratio method and in 64.0% of patients according to the wheal size method and erythema size method. The proportion of subjects who showed a negative result with the allergen/histamine ratio method but positive results with the wheal size method or erythema size method was 15.8%. This group had a significantly higher total nasal symptom score, especially rhinorrhea and nasal obstruction, than subjects who showed negative results on all three methods. CONCLUSION: When diagnosing allergic rhinitis patients using the skin prick test, the wheal size method and erythema size method should be considered rather than the allergen/histamine ratio method.

Hepatic Sarcoidosis in a Patient with Chronic Hepatitis B Virus Infection

Sarcoidosis is a systemic inflammatory granulomatous disease affecting multiple organs, including liver, spleen, heart, eyes, and skin. Liver involvement is reported in 11.5% of cases and many studies have reported on the association between hepatitis C virus infection and sarcoidosis. However, the role of hepatitis B virus (HBV) infection as a trigger for sarcoidosis has never been reported. We describe a case of hepatic sarcoidosis in a patient with chronic hepatitis B infection, with a possible link between the two. It is the first case report of a patient with interferon-alpha-naive chronic HBV infection presenting with hepatic sarcoidosis accompanied by portal hypertension and liver cirrhosis.

A Case of Aortitis with Systemic Lupus Erythematosus

A 21-year-old woman with a history of systemic lupus erythematosus (SLE) was admitted with dyspnea on exertion for a year. A transesophageal echocardiogram showed dilated aortic root with intimal thickening. A positron emission tomography/computed tomography demonstrated increase in glucose hypermetabolic along the walls of the aortic valve, ascending aorta, aortic arch, and aorta, vasculitis was observed. She underwent the Bentall operation due to inflammation at sinus of right coronary cusp. She started high dose glucocorticoid after the operation. Currently she is able to sustain with low dose steroid after gradually tapered. Her symptoms were disappeared, and inflammatory markers decreased to within the normal range. Aortitis and aortic aneurysms are an uncommon manifestation of SLE. Furthermore, almost of lupus patients with medium and large vessel vasculitis are not biopsied or studied histologically. We present first case in Korea that was a 21-year-old woman who diagnosed with lupus aortitis by pathology after aortic valve replacement operation.

A Case of Agenesis of the Dorsal Pancreas with Concomitant Pancreatic Ductal Adenocarcinoma in an Adult Patient / 대한췌담도학회지

Agenesis of dorsal pancreas (ADP) is an extremely rare congenital anomaly defined as an absence of the dorsal ductal system resulting from failure in the embryologic development of the pancreatic dorsal bud. Most of ADP patients are asymptomatic but some of them suffer recurrent pancreatitis and diabetes. Few number of pancreatic adenocarcinoma in association with ADP has been published previously in other countries. There was no such case reported in Korea. We report a case diagnosed as pancreatic adenocarcinoma with ADP.

Sublingual immunotherapy for allergic rhinitis

Allergen specific immunotherapy is a medical treatment aiming at patients suffering from allergies that are insufficiently controlled by symptomatic treatments. Allergen immunotherapy rehabilitates the immune system. Subcutaneous immunotherapy (SCIT) is the historical route of administration and consists of allergen extract injections. SCIT has proven efficacy in allergic rhinitis and asthma, but it requires regular injections at the hospital and carries the risk of potentially serious systemic allergic reactions in response to the treatment itself. Sublingual immunotherapy (SLIT) offers several specific advantages over SCIT. SLIT is more easily administered, avoids cumbersome injections regimens, and carries a much lower risk of anaphylactic shock compared with SCIT. So, this article will discuss the mechanisms of action, advantages, and limitations of SLIT for allergic rhinitis.

Clinical Analysis of Auricular Benign Masses

BACKGROUND AND OBJECTIVES: Auricular masses are growths on the outer ear that have not been well characterized clinically. We assessed the clinical nature and treatment of auricular benign masses in patients at our institution. SUBJECTS AND METHODS: We retrospectively identified 63 patients with auricular benign masses who underwent excision and biopsy from May 1970 to April 2011. We determined the site, cause, size, pathology and postoperative results of these auricular masses. RESULTS: Auricular benign masses occurred most commonly on the lobule (44.4%), followed by the tragus (20.6%), crus of helix (11.1%), triangular fossa (6.3%), crus of antihelix-antitragus (3.1%) and scapha (1.5%). Pathologically, the most common type of auricular mass was epidermal cysts (25.3%), followed by hypertrophic scar (12.6%), fibrous tissue-accessory ear (9.5%), chronic inflammation-nevus (7.9%), keloid (6.3%), hemangioma (4.7%), and skin tag-seborrheic keratosis (3.1%). CONCLUSIONS: The most common site of auricular benign masses is the lobule and most common pathology is an epidermal cyst.

A Case of Intra-Abdominal Kikuchi's Disease with Increased FDG Uptake on PET-CT that Mimicked Intra-Abdominal Lymphoma

Kikuchi's disease is a benign disease characterized mainly by fever and cervical lymphadenitis. We report a case of Kikuchi's disease that manifested as intra-abdominal lymphadenitis. A 39 year old woman presented with fever that had persisted for one week. Her history and physical examination were unremarkable. The laboratory findings revealed mild leukopenia and increased C-reactive protein. Abdominal CT revealed multiple lymph node enlargements in the mesenteric root and around the ileocecal valve. Positron emission tomography-computed tomography (PET-CT) revealed increased 18-fluoro-deoxyglucose(FDG) uptake in the lymph nodes observed by abdominal CT. A laparoscopic excisional biopsy of the lymph node was performed for a confirmatory diagnosis and the pathology findings were compatible with Kikuchi's disease. Although intra-abdominal Kikuchi's disease is a rare disease, it should be considered in a differential diagnosis of intra-abdominal lymphadenopathy with increased FDG uptake on PET-CT.

The Clinical Significance of Aortic Pulse Wave Velocity in Korean Adults

BACKGROUND: As recent studies show that pulse pressure (PP) is the most potent predictor of cardiovascular diseases, many studies focus on the non-invasive methods to evaluate arterial stiffness influencing on pulse pressure. This study attempted to show the relationship between cardiovascular risk factors and aortic pulse wave velocity (PWV) as a classical factor of arterial stiffness in Korean adults. METHODS: The subjects were 305 adults who had visited a health care center of a university medical center in Suwon from December, 2003 to April, 2004. We had measured the aortic pulse wave velocity through auto PWV analyzer (PP-1000, Hanbyul Meditech, Korea) and had compared the relationships with smoking, total cholesterol, high density lipoprotein, low density lipoprotein, body mass index, sex, age, systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and fasting glucose. RESULTS: There were positive correlation between aortic pulse wave velocity and age (P=0.001), fasting blood sugar (P=0.013), systolic blood pressure (P=0.007), diastolic blood pressure (P=0.038), mean blood pressure (P=0.012), pulse pressure (P=0.035), total cholesterol (P=0.009), low density lipoprotein (P=0.023). There were significant differences of the groups by sex (P=0.029). CONCLUSION: The estimation of the aortic pulse wave velocity (PWV) using the auto PWV analyzer (PP-1000, Hanbyul Meditech, Korea) seems to be a useful diagnostic method of early detection of atherosclerosis for management and prevention of cardiovascular diseases. In future more data about correlations between cardiovascular risk factors and pulse wave velocity and methods managing these factors, and more studies for determining the meaningful values of pulse wave velocity, in larger cases are needed.

External Fixation Of Lower Limb Fractures In Children / 대한정형외과학회잡지

PURPOSE: To evaluate the results and the usefulness of the external fixator for the treatment of the lower limb fractures in children. MATERIALS AND METHODS: We used 22 children fractures of lower limb treated with external fixator. There were 14 isolated femur or tibia fractures, 2 both femur and tibia fractures, 1 bilateral tibial fractures, 5 fractures associated with others, and were 10 open and 16 closed fracture. We assessed the axial alignment and leg-length discrepancy, and the range of motion of the joints and complications. RESULTS: The average union and fixation time were 8.1 and 9.5 weeks. Average of 2.4 degrees of varus or valgus and 3.8 degrees of anterior or posterior angulation were obtained. At follow-up, the range of LLD was -1.3 to +1.5cm. CONCLUSION: External fixator in lower limb fractures of children is useful to open fractures, multiple fractures, and unstable fractures to minimize complications.

RISA (Radioiodinated Serum Albumin) Cisternographic Study in Diagnosis of the Hydrocephalus

Cisternography is isotopic demonstration of CSF dynamics, CSF rate & pathways, by scintillation scanning of the head after intrathecal administration of RISA. We have investigated the cisternographic findings in the hydrocephalus patients in view of the diagnosis and prognostic criteria. Cisternography provides the etiology & classification of hydrocephalus and reliable indication of CSF shunt operation. We found correlation between prolonged ventricular retention, delayed migration, inadequate clearance of the isotope and favorable response to shunting.