Characteristics of voice problems occurring with professional voice users are not too different from those with general public. However, they react sensitively to relatively subtle changes of voice and have strong demands for their treatments as well. Consequently, treatments for the professional voice users should be implemented in the form of team approach consisting of not only otolaryngologists with plenty of treatment experience and sufficient knowledge but also speech-language pathologist, vocal coach. While treating professional voice users is burdensome and a challenging problem even to otolaryngologists rich in experience, knowledge and experience obtained through treating them will be much help for voice treatments of other general public. In this article, the authors have reviewed approaches and treatment directions for voice problems occurring with professional voice users.
Dysphonia ; Voice

A 60 year old male patient with a medical history of pulmonary tuberculosis presented with severe headaches and general weakness. Radiological studies revealed mass lesions both in the right using and the right cerebellar hemisphere. Clinically metastatic brain tumor and tuberculoma were highly suspected. The cerebella mass was totally excised and an unusual pathologic result was reported as botryomycosis. According to literatures reviewed, botryomycosis is a chronic bacterial infectious lesion resembling actinomycosis and mycotic abscess and it has been frequently reported in the skin, subcutaneous lesions and other visceral organs, but the cases of brain involvement were extremely rare. This article is a case report of a cerebellar botryomycosis. The pathologic characteristics and the differential diagnosis of botryomycosis are discussed.
Abscess ; Actinomycosis ; Brain ; Brain Neoplasms ; Diagnosis, Differential ; Headache ; Humans ; Male ; Middle Aged ; Skin ; Tuberculoma ; Tuberculosis, Pulmonary

OBJECTIVE: To compare the clinical outcomes of patients with vitrified-thawed embryos transferred using either the 0.25 mL straw method and the pull and cut straw (PNC) method. To evaluate the clinical outcomes of patients with transferred embryos that underwent assisted hatching at the cleaved embryo (day 3) or the blastocyst (day 5) stage. METHODS: The study population consisted of women who underwent vitrified-warmed embryo transfer between May 2000 and December 2011 and assisted hatching was performed after warming of embryos. Cycles of thawing between assisted hatching treated and non treated groups were compared for survival and pregnancy rates. RESULTS: The PNC vitrification method improved survival and pregnancy rates in partial lysed embryos. While assisted hatching did not affect the developmental and clinical pregnancy rates of the vitrified-warmed blastocyst group, it did increase the pregnancy rate of poor quality vitrified-warmed cleaved embryos. CONCLUSION: These results suggest that PNC may increase the number of clinical pregnancies via the vitrification of both cleaved embryos and blastocysts. In addition, selective assisted hatching treatment of embryos that show a poor prognosis after warming may increase the rate of clinical pregnancy.
Blastocyst ; Embryo Transfer ; Embryonic Structures ; Female ; Humans ; Pregnancy ; Pregnancy Rate ; Prognosis ; Vitrification

BACKGROUND: Exertional rhabdomyolysis, although uncommon, is a severe critical illness due to acute renal failure(ARF) and other complications. This study evaluated the clinical, laboratory characteristics of exertional rhabdomyolysis. METHODS: A retrospective study was conducted which examined 26 patients with exertional rhabdomyolysis from Apr. 2000 to Oct. 2001. RESULTS: Fourteen patients(54%) were diagnosed with heat stroke which mostly occurred as a result of a forced march and 12 patients(46%) were diagnosed with exercise-induced rhabdomyolysis which mainly occurred during basic or guerrilla training. All the patients were severely dehydrated and 8 patients(31%) presented with shock. The patients diagnosed with heat stroke were more at risk to shock, seizures, and disseminated intravascular coagulation, than patients who were not diagnosed with heat stroke. Sixteen patients(62%) were diagnosed with ARF(oliguric ARF 9, non-oliguric ARF 7). Seven patients with oliguric ARF received renal replacement therapy. Most patients presented with normal or hypokalemic state in spite of frequent renal failure and metabolic acidosis. Eight patients(31%), mainly diagnosed with heat stoke, were in hypokalemic state and 4 patients(15%) were in hypophosphatemic state. Three patients(20%) died. Of those who survived, three patients suffered from persisting CNS dysfunction. All of them were victims of the heat stroke. CONCLUSION: Acute renal failure was a common complication of exertional rhabdomyolysis. Severe dehydration, shock, and hypokalemia were common during the early course of exertional rhabdomyolysis, especially in patients with heat stroke which was a main, poor prognostic factor of exertional rhabdomyolysis.
Acidosis ; Acute Kidney Injury* ; Critical Illness ; Dehydration ; Disseminated Intravascular Coagulation ; Heat Stroke ; Hot Temperature ; Humans ; Hypokalemia ; Renal Insufficiency ; Renal Replacement Therapy ; Retrospective Studies ; Rhabdomyolysis* ; Seizures ; Shock

BACKGROUND: Adenosine monophosphate-activated protein kinases (AMPKs), as a sensor of cellular energy status, have been known to play an important role in the pathophysiology of diabetes and its complications. Because AMPKs are known to be expressed in podocytes, it is possible that podocyte AMPKs could be an important contributing factor in the development of diabetic proteinuria. We investigated the roles of AMPKs in the pathological changes in podocytes induced by high-glucose (HG) and advanced glycosylation end products (AGEs) in diabetic proteinuria. METHODS: We prepared streptozotocin-induced diabetic renal tissues and cultured rat and mouse podocytes under diabetic conditions with AMPK-modulating agents. The changes in AMPKalpha were analyzed with confocal imaging and Western blotting under the following conditions: (1) normal glucose (5mM, =control); (2) HG (30mM); (3) AGE-added; or (4) HG plus AGE-added. RESULTS: The density of glomerularphospho-AMPKalpha in experimental diabetic nephropathy decreased as a function of the diabetic duration. Diabetic conditions including HG and AGE changed the localization of phospho-AMPKalpha from peripheral cytoplasm to internal cytoplasm and peri- and intranuclear areas in podocytes. HG reduced the AMPKalpha (Thr172) phosphorylation of rat podocytes, and similarly, AGEs reduced the AMPKalpha (Thr172) phosphorylation of mouse podocytes. The distributional and quantitative changes in phospho-AMPKalpha caused by diabetic conditions were preventable using AMPK activators, metformin, and 5-aminoimidazole-4-carboxamide-1beta-riboside. CONCLUSION: We suggest that diabetic conditions induce the relocation and suppression of podocyte AMPKalpha, which would be a suggestive mechanism in diabetic podocyte injury.
Adenosine* ; AMP-Activated Protein Kinases ; Animals ; Blotting, Western ; Cytoplasm ; Diabetic Nephropathies ; Glucose ; Glycosylation End Products, Advanced ; Metformin ; Mice ; Natural Resources ; Phosphorylation ; Podocytes* ; Protein Kinases* ; Proteinuria ; Rats

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.
Adult ; Age of Onset ; Arthritis, Gouty ; Female ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Joints ; Korea* ; Male ; Obesity ; Renal Insufficiency, Chronic ; Retrospective Studies ; Seoul ; Ultrasonography ; Uric Acid

Blossom blight in strawberry was first observed in a green house in Nonsan, Damyang, and Geochang areas of Korea, between early January to April of 2012. Disease symptoms started as a grey fungus formed on the stigma, which led to the blossom blight and eventually to black rot and necrosis of the entire flower. We isolated the fungi purely from the infected pistils and maintained them on potato dextrose agar (PDA) slants. To test Koch's postulates, we inoculated the fungi and found that all of the isolates caused disease symptoms in the flower of strawberry cultivars (Seolhyang, Maehyang, and Kumhyang). The isolates on PDA had a velvet-like appearance, and their color ranged between olivaceous-brown and smoky-grey to olive and almost black. The intercalary conidia of the isolates were elliptical to limoniform, with sizes ranging from 5.0~10.5 x 2.5~3.0 microm to 4.0~7.5 x 2.0~3.0 microm, respectively. The secondary ramoconidia of these isolates were 0- or 1-septate, with sizes ranging betweem 10.0~15.0 x 2.5~3.7 microm and 8.7~11.2 x 2.5~3.2 microm, respectively. A combined sequence analysis of the internal transcribed spacer regions, partial actin (ACT), and translation elongation factor 1-alpha (TEF) genes revealed that the strawberry isolates belonged to two groups of authentic strains, Cladosporium cladosporioides and C. tenuissimum. Based on these results, we identified the pathogens causing blossom blight in strawberries in Korea as being C. cladosporioides and C. tenuissimum.
Actins ; Agar ; Chungcheongnam-do ; Cladosporium* ; Flowers* ; Fragaria* ; Fungi ; Glucose ; Korea* ; Necrosis ; Olea ; Peptide Elongation Factors ; Sequence Analysis ; Solanum tuberosum ; Spores, Fungal

Nasal septal infection can result from progression of a fungal infection from the adjacent sinuses. Nasal septal fungal abscesses complicating nasal trauma, surgical procedures, sinus, and dental infections have previously been reported in a small number of cases. Adequate management involves early diagnosis, prompt empiric antifungal therapy, and surgical debridement in order to prevent the development of life-threatening complications. We report a rare case of nasal septum necrosis from Aspergillus infection in a 79-year-old man with diabetes mellitus and chronic renal failure following endoscopic sphenoid sinus surgery due to an isolated sphenoid fungal ball.
Abscess ; Aged ; Aspergillosis* ; Aspergillus ; Bacterial Infections* ; Debridement ; Diabetes Mellitus ; Early Diagnosis ; Humans ; Kidney Failure, Chronic ; Nasal Septum* ; Necrosis ; Sphenoid Sinus*

BACKGROUNDS/AIMS: Mesenchymal stem cells (MSCs) have the capacity to differentiate into hepatocytes, The purpose of this study is to investigate the MSCs' differentiation process and therapeutic potentials by comparing isolated MSCs with HGF-treated MSCs in rat's model with thiacetamide (TAA)-induced cirrhosis. METHODS: Male Sprague-Dawley (SD) rats, weighing 100-150 g were used in this study. To induce liver fibrosis, recipient rats were taken with 0.04% thioacetamide (TAA) in the drinking water (400 mg TAA/L) for 8 weeks. The rats underlying liver cirrhosis were divided into 3 groups according to the transplanted materials, compared to normal saline as control (I) and isolated MSCs (II) HGF-treated MSCs. RESULTS: Severe hepatic fibrosis and hepatocyte destruction were detected in the control group. Less hepatic cirrhosis and collagen formation, more hepatocyte regeneration and glycogen storage were detected in isolated MSCs compared to HGF-treated MSCs group, Distribution of red autofluorescence is mainly localized near the sinusoids in isolated MSCs, scattered away the sinusoids in HGF-treated MSCs group. MSCs transdifferentiated into CK-19 postive Oval cells and then to albulmin-producing hepatocytes, HGF treated MSCs differentiated into hepatocyte without the intermediate oval cells phase. HGF treated MSCs became the CK18-positive, MSCs became CD 90-positive. CONCLUSIONS: Significant hepatocyte differentiation occurred in not HGF-treated MSCs but isolated MSCs group unexpectedly. These results suggest that the beneficial effect of MSCs on in rat's model with TAA-induced cirrhosis may occur during early differentiation course of MSCs. Mature hepatocyte itself has a little effect on the accelerated differentiation and functional capacity of hepatic lineage cell-line.
Animals ; Collagen ; Drinking Water ; Fibrosis ; Glycogen ; Hepatocytes ; Humans ; Liver ; Liver Cirrhosis ; Male ; Mesenchymal Stromal Cells ; Rats ; Regeneration ; Thioacetamide ; Transplants

Ampullary adenoma is a benign neoplasm with malignant potential that arises from the glandular epithelium of the ampulla of Vater. When the tumor is confined to the ampulla, abdominal sonogram and CT scan can show dilatation of the common bile duct or pancreatic duct, but the mass itself may not be seen. And even biopsies are done, the confirmation of malignant change is frequently missed, and it may be impossible to assess the presence of carcinoma in situ or invasive carcinoma without complete exicision of the lesion. So complete surgical resection is recommended because of extensive growth of the ampullary adenoma and its malignant potential. Recently, we experienced a case of about 0.8 x 1.0 cm sized tumor of the ampulla of Vater that was diagnosed as villous adenoma on endoscopic biopsy, and malignant change was found on resected surgical specimen.
Adenoma ; Adenoma, Villous* ; Ampulla of Vater* ; Biopsy ; Carcinoma in Situ ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Dilatation ; Epithelium ; Pancreatic Ducts ; Tomography, X-Ray Computed