Praziquantel Treatment of Eosinophilic Gastritis Suspected to Be Due to Cerebral Sparganosis / 대한내과학회지

Eosinophilic gastritis is characterized by eosinophilic infiltration of the gastrointestinal tract, which is associated with abdominal pain, diarrhea, nausea, and vomiting. The possible etiologies of secondary eosinophilic gastritis, including drug reactions, parasitic infestation, and malignancy, must be evaluated. Herein we report the case of a 65-year-old North Korean defector who presented with nausea and vomiting for 1 year. Secondary (reactive) eosinophilic gastritis caused by cerebral sparganosis was suspected after a workup that included brain magnetic resonance imaging, cerebrospinal fluid tapping, and gastric mucosal biopsy. The patient showed dramatic clinical improvement with high-dose praziquantel treatment. Even though secondary (reactive) eosinophilic gastritis caused by parasites is very rare, this case shows the importance of considering parasitic infection in eosinophilic gastritis.

Retroperitoneal Fibrosis Associated with Immunoglobulin G4-related Disease / 대한소화기학회지

No abstract available.

Empyema caused by Clostridium perfringens / 영남의대학술지

Pleuropulmonary diseases caused by Clostridial species infections are rare, but have a mortality rate of up to 30%. Furthermore, older people are at greater risk of developing invasive clostridium infections, and the majority of reported cases of clostridium empyema have been attributed to iatrogenic trauma or aspiration. The authors report a case of spontaneous empyema caused by Clostridium perfringens. A 72-year-old woman was admitted to Kangwon National University Hospital for empyema. The patient had no history of trauma, a dental procedure, or aspiration, and was treated using empirical antibiotics and by drainage of pleural fluid. Bacteria species that cause empyema are usually not detected, but on the 4th day of admission, C. perfringens was isolated from the pleural space. The patient was continuously treated with antibiotics for C. perfringens and drainage, and was discharged 25 days after admission with almost a fully recovered status. Increased awareness of Clostrium species infection in the elderly is needed to ensure appropriate treatment.

Two Cases of Unilateral Nasoseptal Pedicled Rotational Mucosal Flap and Interpositional Dermal Allograft for Septal Perforations / 대한이비인후과학회지

A nasoseptal perforation is a defect of cartilage, bone, and mucosa of nasal septum, caused by nasal surgery, malignancy, inflammation, or drugs. Although various surgical treatments and procedures are well known, there is no consensus on the procedures due to low success rate (25-90%) and high recurrence rate (12-48%). One of the major factors that affect surgical results is the size of perforation. For large perforations, the surgical success rate is reported to range from 23% to 70%. The authors report two successful cases of repair surgery of nasoseptal perforation, using unilateral pedicled nasoseptal rotational mucosal flap with releasing incision and interpositional dermal allograft. Although larger study populations and long-term follow-up periods are needed, the authors believe that our method is an effective way to minimalize possible inconveniences observed in the cases of comparatively large perforations, or where there is a lack of autografts or donor site defects.

A Case of Sclerosing Polycystic Adenosis of Parotid Gland / 대한이비인후과학회지

Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To our knowledge, 53 cases of SPA have been reported in the literature to date. SPA is well circumscribed, yet not encapsulated. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important in making the correct diagnosis. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis and benign/malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. In this article, we describe a 38-year-old male patient diagnosed with SPA in the parotid gland.

A Case of Takotsubo Cardiomyopathy in a Young Female with Infective Endocarditis / 대한내과학회지

Takotsubo cardiomyopathy is a clinical syndrome characterized by chest pain, transient left ventricular dysfunction, and specific electrocardiographic changes induced by physical or emotional stress. We describe a rare case of this syndrome associated with acute mitral valve bacterial endocarditis in a young female.

Analysis of Correlation between Results of Polysomnography and Obstructive Structure by Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Polysomnography (PSG) is useful for the diagnosis of obstructive sleep apnea (OSA) and the analysis of its occurrence and severity. Nevertheless, physical examination and PSG are not sufficient to localize the obstructed structure before operation. Drug-induced sleep endoscopy (DISE), on the other hand, is expected to provide an accurate diagnosis as it can be used to evaluate the intensity of operative effect and can minimize additional unnecessary procedures. The aim of this study is to analyze correlation between the results of polysomnography and obstructive structure by DISE in OSA Patients. SUBJECTS AND METHOD: This study was conducted on 75 patients, who were diagnosed with OSA by PSG and DISE. Obstruction levels and individual structures were classified by modified VOTE classification. The patients were divided into groups according to the results of PSG and BSI; the correlation between DSI results and each of these groups were analyzed. RESULTS: There were no statistically significant differences in obstruction levels between PSG data and DISE finding. Obese patients, positional-dependent OSA and sleep stage non-dependent OSA (NREM OSA) groups showed more obstruction on the lateral pharyngeal wall. Severe OSA groups showed more obstruction on tonsils. Obese patient groups revealed more obstruction on tongue base, but did not contribute to statistically significant results. CONCLUSION: In our study, obese patients, severe OSA, positional-dependent OSA and NREM OSA groups tended to exert greater influence on the obstruction of lateral pharyngeal wall. Surgeons should be aware of these findings when performing sleep surgery.

A Case of Prosthetic Knee Joint Infection Caused by Streptococcus agalactiae

Recently the incidence of Group B streptococcus (Streptococcus agalactiae) infection has been increased in nonpregnant adults, especially including the elderly and those with underlying diseases. One year ago, a 72-year-old diabetic woman underwent both total knee replacement and then received intermittently acupuncture due to both knee pain. Five days ago, she developed painful swelling on right knee joint. The synovial fluid showed leukocytosis (WBC 8,200/mm3), she was diagnosed as prosthetic joint infection, and treated with cefazolin. Her condition was rapidly aggravated despite of antibiotics therapy, open debridement and drainage was performed. But she expired due to sepsis. Both blood and synovial fluid culture yielded S. agalactiae. We reported a case of prosthetic knee joint infection caused by S. agalactiae.

A Subjective and Acoustic Analysis on Voice Change after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some chronic sinusitis patients complain that voice change, which occurs during surgeries such as endoscopic sinus surgery (ESS), can lead to changes in the vocal organ. The purpose of this study is to analyze the effect of ESS on voice by questionnaire and voice analysis. SUBJECTS AND METHOD: Thirty patients (male 15, female 15) who had underwent ESS were enrolled. All patients had sinusitis confirmed by preoperative CT scan. We analyzed subjective voice impairment by way of questionnaire (Korean-Version of Voice Handicap Index, KVHI) and objective voice impairment by Computerized Speech Laboratory one day preceding and at one month following the surgery. Finally, the subjective impairment of voice was analyzed by subjective questionnaire at postoperative 6 months. In objective analysis, we analysis 11 ESS cases on the formant frequencies of five vowels (/a/, /i/, /u/, /e/, /o/) and three nasal consonants (/namu/, /nuna/, /umma/). RESULTS: In the questionnaire (KVHI), there was a little change in the functional, physical and emotional field but the results were not statistically significant (p>0.05). In the voice analysis, the first formant frequencies of /a/, /u/, the third formant frequency of /o/ of vowel and /a/ of /namu/ of nasal consonant were significantly increased postoperatively compared to those of the preoperative status (p<0.05). However, there was no major change. There was no subjective voice impairment at 6 months after operation. CONCLUSION: After ESS, some voice impairment were observed in KVHI and some formant frequencies were increased in the objective voice analysis but without serious major voice changes. We conclude that ESS is relatively safe from voice point of view; however, for some professional voice users, particular attention needs to be paid regarding fine voice changes.

Retrospective Analysis of Endoscopic Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We reviewed retrospective data of patients who underwent endoscopic septoplasty over 5 years and provide clinical information about endoscopic septoplasty. SUBJECTS AND METHOD: The medical records of patients who underwent endoscopic septoplasty were reviewed retrospectively for clinical symptoms, surgical methods, intraoperative technique, operation time, postoperative complications and results. RESULTS: Nasal obstruction was the most common presenting symptom. Among patients, endoscopic septoplasty alone was performed in 290 cases. Among 290 cases, 57 cases were of broad based septal defection, 13 cases septal deflection with septal spur, 16 cases isolated septal spur and 4 cases limited posterior septal deflection. The mean operation time was 32.48+/-2.76 minutes. No major complication occurred in the immediate postoperative period. Minor complications included septal hematoma (3.79%) and postoperative hemorrhage (1.03%). Sixty-five patients received statistically validated measures of Visual Analog Scale (VAS) at 1 month and 6 months after surgery. VAS score decreased statistically from 7.75 to 0.81 at 6 mon-ths after operation (p<0.05). CONCLUSION: Endoscopic septoplasty is a relatively safe and effective technique used to treat various types of septal pathology such as classical septal deviation, septal spur and isolated septal deflection. Endoscopy with video imaging system is valuable for education.

Clinical Safety of PMR(Palatal Muscle Resection) In Which Performed OSAS Patients

BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze clinical safety of PMR(Palatal Muscle Resection) in obstructive sleep apnea patients. MATERIALS AND METHODS: Fourteen Patients underwent only PMR were reviewed retrospectively. ESS(Epworth Sleepiness Scale) was analyzed after PMR surgery to assess surgical results. Visual Analogue Scale were reviewed to evaluate postoperative pain. Eustachian tube function test, voice analysis, and measurement of forced expiration power were done after two months of surgery. RESULTS: ESS were improved after PMR. There were little postoperative pain. There was no significant change is observed vowel sounds except /u/ nor postoperative nasalization in voice, Eustachian tube dysfunction and change of expiration power. CONCLUSION: PMR may be regarded clinically safe surgery in obstructive sleep apnea patient.

A Case of Chondro-Osseous Respiratory Epithelial Adenomatoid Hamartoma Originated from Nasal Cavity

Hamartoma is a non-malignant malformation or developmental anomaly of tissue development that may occur anywhere in the body but is rarely reported in the nasal cavity, paranasal sinuses, or nasopharynx. Chondro-osseous respiratory epithelial adenomatoid hamartoma (CO-REAH) of the nasal cavity is exceedingly rare, and can be confused both grossly and microscopically with more serious sinonasal tumors. We present the case of a 58-year-old man with a nasal cavity mass, which was removed by an endonasal approach. Radiographic and histological studies permitted a diagnosis of CO-REAH in this case.

Ectopic Eruption of a Tooth into the Nasal Cavity with Sinusitis: A Case Report

The ectopic eruption of teeth into the nasal cavity is a rare phenomenon. Ectopic tooth eruptions commonly occur in the palate and maxillary sinus, but have also been reported in the mandibular condyle, coronoid process, orbit, and nasal cavities. The clinical manifestations of intranasal teeth are quite variable; however, intranasal teeth can be an incidental finding during routine examination in patients without nasal discomfort. Herein we report a unique case of an intranasal ectopic tooth that erupted into the nasal cavity and caused significant nasal symptoms in an otherwise healthy patient. The intranasal tooth was removed endoscopically.

The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ankyloglossia, manifested by the short and lingual frenulum, can affect tongue mobility and articulation. The purpose of this study is to evaluate the improvement of tongue mobility and articulation in patients with akyloglossia, which is treated by frenotomy. SUBJECTS AND METHOD: A prospective study was done for 81 patients with ankyloglossia undergoing frenotomy, and who were aged between 2 to 10 years old. Outcomes were assessed by measuring tongue mobility, analyzing the articulatory evaluation and reviewing patient questionnaires. RESULTS: The mean length of tongue elevation improved from 7.4 mm preoperatively to 16.3 mm postoperatively (p<0.05). Similarly, the mean length of tongue protrusion improved from 15.0 mm to 26.0 mm (p<0.05). The mean articulation score improved from 8.5 to 9.9 (p<0.05). Parents' subjective satisfaction scores improved from 2.3 to 3.2 (p<0.05). CONCLUSION: Tongue mobility and articulation improved after frenotomy in patients with ankyloglossia.

Purification of Protein Expressed from Three Different Regions of Norovirus (NoV)

Norovirus (NoV), which belongs to the family Caliciviridae, is one of the major causes of nonbacterial acute gastroenteritis in the world. In this study, we purified proteins from the epitope region of norovirus for development of the rapid diagnosis system using polyclonal antibodies. As antigens, parts of the ORF (open reading frame) 2, ORF2-P domain, ORF2-Epi, and ORF3 regions were selected and their expressions were induced. The antigenicity of the purified proteins was identified by Western blotting. Each of the purified proteins was injected into mice for the production of novel antibodies and after 3 months of immunization, sera from the mice were obtained. The polyclonal antibody titer was tested by enzyme-linked immunosorbent assay (ELISA) and antibody against ORF2-Epi showed the highest titer. Those polyclonal antibodies can be used in further immunoassay for the rapid detection of NoVs from food and clinical specimens.

Role of N-terminal Hydrophilic Amino Acids in Molecular Translocation of CTLA-4 to Cell Surface

BACKGROUND: This study was aimed to differentiate two forms of CTLA-4 (CD152) in activated peripheral blood lymphocyte and clarify the mechanism how cytoplasmic form of this molecule is targeted to cell surface. METHODS: For this purpose we generated 2 different anti-human CD152 peptide antibodies and 5 different N'-terminal deletion mutant CTLA4Ig fusion proteins and carried out a series of Western blot and ELISA analyses. Antipeptide antibodies made in this study were anti-CTLA4pB and anti- CTLA4pN. The former recognized a region on extracellular single V-like domain and the latter recognized N'-terminal sequence of leader domain of human CD152. RESULTS: In Western blot, the former antibody recognized recombinant human CTLA4Ig fusion protein as an antigen. And this recognition was completely blocked by preincubating antipeptide antibody with the peptide used for the antibody generation at the peptide concentration of 200 ug/ml. These antibodies were recognized human CD152 as a cytoplasmic sequestered- and a membrane bound- forms in phytohemagglutinin (PHA)- stimulated peripheral blood lymphocyte (PBL). These two forms of CD152 were further differentiated by using anti-CTLA4pN and anti-CTLA4pB antibodies such that former recognized cytosolic form only while latter recognized both cytoplasmic- and membrane- forms of this molecule. Furthermore, in a transfection expression study of 5 different N'-terminal deletion mutant CTLA4Ig, mutated proteins were secreted out from transfected cell surface only when more than 6 amino acids from N'-terminal were deleted. CONCLUSION: Our results implies that cytosolic form of CTLA-4 has leader sequence while membrane form of this molecule does not. And also suggested is that at least N'-terminal 6 amino acid residues of human CTLA-4 are required for regulation of targeting this molecule from cytosolic- to membrane- area of activated human peripheral blood T lymphocyte.