Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.
Cholesteatoma* ; Ear, Inner ; Female ; Fistula* ; Hearing Loss, Sensorineural ; Humans ; Labyrinthitis ; Meniere Disease ; Middle Aged ; Neuroma, Acoustic ; Otitis Media ; Semicircular Canals ; Vertigo* ; Vestibular Neuronitis

No abstract available.
Blood Pressure* ; Membranes* ; Thyroid Diseases* ; Thyroid Gland*

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.
Diagnosis ; Ear Diseases ; Ear, Inner ; Head ; Humans ; Labyrinthitis ; Retrospective Studies ; Semicircular Canals* ; Vertigo*

BACKGROUND/AIMS: To review the cases of surgically-treated intrahepatic cholangiocarcinoma, and to evaluate the clinical and pathologic features of intrahepatic cholangiocarcinoma that may affect longterm survival among Korean patients. MATERIALS AND METHODS: From 1990 to 1997, 28 patients with intrahepatic cholangiocarcinoma underwent laparotomy. Among them, resection was performed in 25 patients and wedge resection in only 3 patients. The liver resections included: 5 right lobectomies, 1 right trisegmentectomy, 7 left lobectomies, 3 extended left lobectomies, 2 hepatopancreatoduodenectomies and 7 segmentectomies. Curative resection was performed on 15 patients. The histological sections of all resected specimens were immunohistochemically stained with p53 and Ki-67 monoclonal antibodies to assess biological behavior of the tumor cells. The cumulative survival rate and clinicopathological factors, including biological markers (p53, Ki-67), that may influence prognosis were analyzed stastistically. RESULTS: The patients undergoing curative resection survived significantly longer than the patients undergoing noncurative resection. The median survival time for patients with curative resection was 24 months (mean, 34+/-8 months) with 1-, 2-, and 3-year survival rates of 66.6%, 44.4%, and 35.6%, respectively. The median survival time for patients with noncurative resection was 3 months (mean, 8+/-3 months) with 1- and 2-year survival rates of 26.7% and 13.4%, respectively. Univariate analysis showed that positive regional lymph node significantly correlated with poor prognosis (p=0.004); and that curative resection significantly correlated with better prognosis (p=0.001). Age, sex, tumor size, the degree of cell differentiation, gross type of tumor, and p53 and Ki-67 labeling index had no significant correlation with prognosis. CONCLUSION: Our results support the idea that an aggressive liver resection along with regional lymph node dissection is recommended for long-term survival. The validity of the molecular biologic tumor markers (p53, Ki -67) as a prognostic factor is not yet clearly defined.
Antibodies, Monoclonal ; Biomarkers ; Cell Differentiation ; Cholangiocarcinoma* ; Fibrinogen ; Hepatectomy ; Humans ; Laparotomy ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Prognosis ; Survival Rate ; Biomarkers, Tumor

BACKGROUND: Quantitation of cytomegalovirus (CMV) DNA using real-time PCR has been utilized for monitoring CMV infection. However, the CMV antigenemia assay is still the 'gold standard' assay. There are only a few studies in Korea that compared the efficacy of use of real-time PCR for quantitation of CMV DNA in whole blood with the antigenemia assay, and most of these studies have been limited to transplant recipients. METHOD: 479 whole blood samples from 79 patients, falling under different disease groups, were tested by real-time CMV DNA PCR using the Q-CMV real-time complete kit (Nanogen Advanced Diagnostic S.r.L., Italy) and CMV antigenemia assay (CINA Kit, ArgeneBiosoft, France), and the results were compared. Repeatedly tested patients were selected and their charts were reviewed for ganciclovir therapy. RESULTS: The concordance rate of the two assays was 86.4% (Cohen's kappa coefficient value=0.659). Quantitative correlation between the two assays was a moderate (r=0.5504, P<0.0001). Among 20 patients tested repeatedly with the two assays, 13 patients were transplant recipients and treated with ganciclovir. Before treatment, CMV was detected earlier by real-time CMV DNA PCR than the antigenemia assay, with a median difference of 8 days. After treatment, the antigenemia assay achieved negative results earlier than real-time CMV DNA PCR with a median difference of 10.5 days. CONCLUSIONS: Q-CMV real-time complete kit is a useful tool for early detection of CMV infection in whole blood samples in transplant recipients.
Antiviral Agents/therapeutic use ; Cytomegalovirus/*genetics ; Cytomegalovirus Infections/drug therapy/pathology/virology ; DNA, Viral/*blood/metabolism ; Ganciclovir/therapeutic use ; Humans ; *Immunoassay ; Organ Transplantation ; Phosphoproteins/genetics/immunology/*metabolism ; *Real-Time Polymerase Chain Reaction ; Viral Matrix Proteins/genetics/immunology/*metabolism ; Virology/*methods

BACKGROUND: We examined the usefulness of urine osmolality, as a predictive factor in the treatment of monosymptomatic nocturnal enuresis (NE) with combination therapy of imipramine and desmopressin. METHODS: From May 2014 to April 2015, 59 monosymptomatic NE patients participated in this study. Early morning urine osmolality was measured at 1 week and 1 day before combination therapy of imipramine and desmopressin, and at 1 week and 2 weeks after therapy. The response to combination therapy was evaluated at 3 months after treatment. The mean period of combination therapy was 6.4+/-4.2 weeks. Therapeutic response was classified as complete (0-1 wet night/week), partial (over 50% reduction of night) and non-responders (less than 50% reduction of night). RESULTS: The cumulative rate of the complete and partial responders was 76.3%. Among the 3 groups, the statistically lowest value of pre-treatment urine osmolality was observed in the complete responder group (p<0.001). Urine osmolality increased in all groups after treatment, however, statistically the greatest difference between pre and post-treatment urine osmolality was observed in the complete responder group (p=0.024). No serious side effects were observed. CONCLUSION: Early morning urine osmolality and change of urine osmolality between pre and post-treatment have predictive values in the response to combined imipramine and desmopressin for treatment of monosymptomatic NE.
Deamino Arginine Vasopressin* ; Enuresis ; Humans ; Imipramine* ; Nocturnal Enuresis* ; Osmolar Concentration*

PURPOSE: Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS. MATERIALS AND METHODS: From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose). RESULTS: The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047). CONCLUSION: In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.
Esophagus ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Radiation Tolerance ; Radiosurgery*

PURPOSE: Cancers are highly individual in their response to chemotherapy, however attempts to predict tumor response to drugs using in vitro cell culture have largely failed. A new technology, the histoculture drug response assay (HDRA), appears to have solved many previous problems. The purpose of this study is to evaluate the reliability of HDRA in a chemosensitivity test for breast cancer. MATERIALS AND METHODS: Tumor specimens from breast cancer patients were evaluated by HDRA using different chemotherapeutic agents. Each specimen was tested using a blind method in order to determine the reproducibility of HDRA results for the same tissue and with a triplicated assay in order to determine reproducibility by different examiners. The evaluative power of this assay and the chemosensitivity of drugs for each specimen was determined. RESULTS: Specimens of 92.9% (65/70) were successfully cultured and evaluated for chemosensitivity. The reproducibility of HDRA for the same tissue was 75% (100% agreement) and 100% (over 70% agreement), respectively. And the reproducibility by different examiners was 78.9% (100% agreement) and 94.7% (over 70% agreement), respectively. Each specimen demonstrated a response to at least one agent. CONCLUSION: The evaluative power and reproducibility of HDRA were high, therefore it might serve as a reliable clinical method for chemosensitivity testing. However, there is a need for clinical trial in which patients are initially randomized for treatment either by HDRA direction or by clinician's choice.
Breast Neoplasms* ; Breast* ; Cell Culture Techniques ; Drug Therapy ; Humans

PURPOSE: This study was to analyse the factors affecting youth smoking, especially self-efficacy and perceived social norm, based on the stage of change. METHODS: A self-reported survey was conducted during the period from the 21st of April to the 17th of May, 2008. Data were collected from 10,707 students of 12 middle schools in Seoul, Gyeonggi-do, and Incheon. The data were analysed with SPSS/WIN 15.0. RESULT: The smoking possibility was 2.18 times higher in the male students than in female students, and 1.76 times higher in 8th-grade students and 2.48 times higher in 9th-grade students than in 7th-grade ones. Smoking possibility increased when students had more experience in alcohol, more friends who smoke, or worse relationship with their parents. Also this study showed that high-level self-efficacy and perceived social norm were acting as inhibiting factors of smoking. CONCLUSION: To reduce the youth's smoking rate, smoking prevention programs should provide educational chances to learn knowledge and skills on how to reject smoking temptation. Also, someone significant like parents should make it clear to the youth that they do not want their children to smoke.
Adolescent* ; Child ; Female ; Friends ; Gyeonggi-do ; Humans ; Incheon ; Male ; Parents ; Seoul ; Smoke* ; Smoking*

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.
Aneurysm ; Aortic Rupture ; Endoleak ; Follow-Up Studies ; Humans ; Mortality ; Thrombosis