No abstract available.
Magnetic Resonance Imaging* ; Subacute Combined Degeneration*

Cysts of thoracic duct are uncommon. The most commonly involved site is the thoracic segment of the thoracic duct followed by the abdominal and cervical segments of the thoracic duct. To date, about 15 cases of cervical thoracic duct cysts have been described in the literature. Information regarding the natural history of these cysts and their pathogenesis is limited. The primary symptom and sign are generally a palpable soft left supraclavicular swelling. We report a case of cervical thoracic duct cyst with a review of literature.
Natural History ; Neck ; Thoracic Duct*

Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the flaviviridae family, and this virus is transmitted by the bite of the mosquito Aedes aegypti. It occurs in the tropical climates of the South Pacific, Southeast Asia, India, Africa and the subtropical zone of America. Imported cases of Dengue fever and Dengue hemorrhagic fever are rapidly increasing as many Koreans are now traveling abroad. Liver injury is usually detected by laboratory investigation according to a surveillance protocol. Although liver injury by dengue virus has been described in Asia and the Pacific islands, the pathogenic mechanisms are not yet fully clarified. It is usually expressed in a self-limiting pattern and the patient has a complete recovery. We report here on a case of a young woman who presented with general weakness, nausea and significant elevation of the aminotransferase levels, and she was diagnosed with dengue fever.
Acute Disease ; Adult ; Dengue Hemorrhagic Fever/complications/*diagnosis/virology ; Dengue Virus/*isolation & purification ; Female ; Hepatitis, Viral, Human/*diagnosis/virology ; Humans

BACKGROUND: Moyamoya disease is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal diameter might be different, but reflects the size of internal carotid artery passing through the bony carotid canal. In this study, we aimed to identify the relationship between bony carotid canal diameter and clinical manifestation. METHODS: 146 consecutive patients diagnosed with moyamoya disease by brain imaging studies were included. We measured the diameter of a transverse portion of bony carotid canal on bone window of a brain computed tomography(CT) image. Patients were divided into two groups, ischemic or hemorrhagic stroke according to clinical manifestation. As a result, 115 patients were included. The Suzuki stage was used as criteria for disease progression. RESULTS: Bony carotid canal diameter was 3.6 ± 0.5 (right) and 3.6 ± 0.4 (left) in the hemorrhagic stroke group, and 3.7 ± 0.4 (right) and 3.6 ± 0.4 (left) in the ischemic stroke group. The bony carotid canal diameter of the moyamoya vessels (3.6 mm) was smaller than the diameter of non-moyamoya vessels (3.8 mm), significantly (p= 0.042). However, there was no difference in the collateral patterns and clinical manifestation in a comparison of both groups. CONCLUSIONS: In our study, there was no significant difference of clinical manifestations and collateral patterns depend on the bony carotid canal diameter in patients with moyamoya disease. These findings suggest that the clinical presentations of moyamoya disease are not related to the onset time of the disease.
Anterior Cerebral Artery ; Brain ; Carotid Artery, Internal ; Constriction, Pathologic ; Disease Progression ; Humans ; Middle Cerebral Artery ; Moyamoya Disease* ; Neuroimaging ; Stroke

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the relationship between the expression of Bcl-2, Bax, p27 and lymph node metastasis (LNM) in papillary thyroid cancer (PTC). SUBJECTS AND METHOD: The thyroid tissue samples were obtained randomly from the department of pathology at Kangbuk Samsung Hospital. The specimens were from 72 patients, comprising 25 patients with thyroid nodular hyperplasia (TNH), 23 PTC without LNM, and 24 PTC with LNM between January 2006 and May 2008. Immunohistochemical staining for Bcl-2, Bax, and p27 was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high (>25% of cells stained) or low (0-25%). RESULTS: Expression of Bcl-2 was scored as high for 1 (4%) TNH, 3 (13%) PTC without LNM and 4 (17%) PTC with LNM cases. Expression of Bax was scored as high for 0 (0%) TNH, 9 (39%) PTC without LNH and 16 (67%) PTC with LNM cases. Expression of p27 was scored as high for 13 (52%) TNH, 12 (52%) PTC without LNM and 13 (54%) PTC with LNM cases. Expression of Bax in the PTC with LNM group was scored higher than TNH (p<.01) and PTC without LNM (p<.05). There was no statistically difference in the immunoreactivity for Bcl-2 and p27 among the three groups. However, some positive expressions of p27 were noted at the cytoplasm of the PTC. CONCLUSION: Our results suggest that immunohistochemical analysis of Bax may be helpful in the diagnosis of PTC and in the evaluation of lymph node metastatic potential in PTC.
Carcinoma, Papillary ; Cytoplasm ; Factor IX ; Humans ; Hyperplasia ; Lymph Nodes ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: Various saline solution formulae for nasal irrigation have been used frequently in patients with rhinosinusitis. However, there are not enough scientific evidences supporting the effect of irrigation of the nose with saline solution. We investigated the effects of saline irrigation on mucus secretion, subjective symptoms, and nasal cavity air-space volume changes in patients with rhinosinusitis. SUBJECTS AND METHOD: The nasal cavities of patients with rhinosinusitis were washed with 0.9%, 3%, and 6% of saline solutions consecutively with about 10 minute intervals. Lavage fluids were collected from the ipsilateral sides to determine the concentrations of mucin and lysozyme. Patients recorded subjective symptoms and each patient's nasal cavity air-space volume was assessed by acoustic rhinometry after each irrigations. RESULTS: The sensation of rhinorrhea, pain, and nasal blockage were increased as the concentration of saline increased. The concentrations of mucin increased with the increasing concentration of saline solution. However, the concentration of lysozyme decreased with the increase in the concentration of saline solution. Futhermore, hypertonic saline solution (6%) decreased the air-space volume significantly. CONCLUSION: The saline solution induces mucin secretion but not lysozyme secretion in patients with chronic rhinosinusitis. These changes in the secretion pattern may change the physical properties of mucus. The hypertonic saline solution may increase the edema of nasal cavity and decrease air-space vol
Edema ; Humans ; Mucins ; Mucus* ; Muramidase ; Nasal Cavity ; Nasal Lavage ; Nasal Obstruction ; Nose ; Rhinometry, Acoustic ; Saline Solution, Hypertonic ; Sensation ; Sinusitis ; Sodium Chloride ; Therapeutic Irrigation

BACKGROUND AND OBJECTIVES: High resolution computed tomography (HRCT) helps locating the anatomical structure within the temporal bone preoperatively. Contracted mastoid has lots of changed anatomical structure and outside in technique tympanomastoidectomy procedure cannot provide safe and effective access. The aims of this study are to analyze changed anatomical structure and to suggest safer and more effective surgical procedures in chronic otitis media patients with contracted mastoid. SUBJECTS AND METHOD: We measured distances between important surgical landmarks and cross sectional area of pneumatized air cells in contracted mastoid, and compared with normal groups. We analyzed postoperative complications between outside in technique and inside out technique tympanomastoidectomy. RESULTS: The shortest distance between the posterior wall of external auditory canal and the anterior edge of the sigmoid sinus, the vertical shortest distance between the superior wall of external auditory canal and the tegmen, and the cross-sectional area of mastoid air cells were significantly small in contracted mastoid group (p<0.05). There were 2 cases of postoperative facial weakness by outside in technique tympanomastoidectomy. CONCLUSION: Contracted mastoid has lots of changed anatomical structure. We suggest that inside out technique tympanomastoidectomy procedure is safer and more effective in patients with contracted mastoid.
Colon, Sigmoid ; Ear Canal ; Humans ; Mastoid* ; Otitis Media* ; Otitis* ; Postoperative Complications ; Temporal Bone

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is the intermittent cessation of breathing during sleep due to the collapse of the pharyngeal airway. Pharyngeal collapsibility and oropharyngeal caliber are affected by the respiratory cycle and the body position. Several methods have been used to evaluate the states of upper airway in patients with OSA according to body positions during wakefulness, but there were no reports about the upper airway states according to body positions during sleep. The aim of this study is to evaluate the states of upper airway in patients with OSA according to body position changes during sleep. MATERIALS AND METHOD: Using a multi detector CT, we studied 10 patients with OSA. Each patient was scanned at supine position during the awake state and then induced to sleep using Midazolam. According to body positions (supine, decubitus, and prone), images were acquired during sleep state. The following 4 transverse levels were obtained to evaluate the minimal cross sectional area, collapsibility index, and airway volume: 1) high retropalate level, 2) low retropalate level, 3) high retroglossal level, 4) low retroglossal level. RESULTS: During sleep, the upper airway cross sectional area was decreased and the airway wall collapsibility was increased. Cross sectional area and airway volume were larger at prone and decubitus positions than supine position. Airway wall collapsibility index was lower at prone and decubitus positions than at the supine position. CONCLUSION: In this study, we confirm that the upper airway collapsibility decreases and the airway caliber increases according to body position changes (prone, decubitus) during sleep. Furthermore, the decubitus position is better than the prone position for improving upper airway patency during sleep.
Humans ; Midazolam ; Prone Position ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Supine Position ; Tomography, Emission-Computed ; Wakefulness

Objective: Chordoma, a rare malignant tumor originating from embryonal notochord remnants, exhibits high resistance to conventional treatments, making surgical resection imperative. However, the factors influencing prognosis specifically for cervical spine chordoma have not been clearly identified. We investigate the prognosis of cervical spine chordoma with factors influential in a nationwide multicenter retrospective study. Methods: This study included all patients diagnosed with cervical spine chordoma at 7 tertiary referral centers from January 1998 to March 2023, excluding those with clivus and thoracic spine chordomas extending into the cervical spine. Local recurrence (LR) was identified through follow-up magnetic resonance imaging, either as reappearance in completely resected tumors or regrowth in residual tumors. The study assessed LR and overall survival, analyzing factors influencing LR and death. Results: Forty-five patients with cervical spine chordoma had a mean age of 46.4 years. Over a median follow-up of 52 months, LR and distant metastasis were observed in 21 (46.7%) and 4 patients (8.9%), respectively, and 16 patients (36%) were confirmed dead. The 5-year and 10-year cumulative LR rates were 51.3% and 60%, respectively, while the 5-year and 10-year survival rates were 82% and 53%. Age was the only significant factor affecting mortality (hazard ratio, 1.04; 95% confidence interval, 1.04–1.07; p=0.015). Notably, the degree of resection and adjuvant therapy did not statistically significantly impact local tumor control and mortality. Conclusion This study, the largest multicenter retrospective analysis of cervical spine chordoma in Korea, identified age as the only factor significantly affecting patient survival.

Objective: Chordoma, a rare malignant tumor originating from embryonal notochord remnants, exhibits high resistance to conventional treatments, making surgical resection imperative. However, the factors influencing prognosis specifically for cervical spine chordoma have not been clearly identified. We investigate the prognosis of cervical spine chordoma with factors influential in a nationwide multicenter retrospective study. Methods: This study included all patients diagnosed with cervical spine chordoma at 7 tertiary referral centers from January 1998 to March 2023, excluding those with clivus and thoracic spine chordomas extending into the cervical spine. Local recurrence (LR) was identified through follow-up magnetic resonance imaging, either as reappearance in completely resected tumors or regrowth in residual tumors. The study assessed LR and overall survival, analyzing factors influencing LR and death. Results: Forty-five patients with cervical spine chordoma had a mean age of 46.4 years. Over a median follow-up of 52 months, LR and distant metastasis were observed in 21 (46.7%) and 4 patients (8.9%), respectively, and 16 patients (36%) were confirmed dead. The 5-year and 10-year cumulative LR rates were 51.3% and 60%, respectively, while the 5-year and 10-year survival rates were 82% and 53%. Age was the only significant factor affecting mortality (hazard ratio, 1.04; 95% confidence interval, 1.04–1.07; p=0.015). Notably, the degree of resection and adjuvant therapy did not statistically significantly impact local tumor control and mortality. Conclusion This study, the largest multicenter retrospective analysis of cervical spine chordoma in Korea, identified age as the only factor significantly affecting patient survival.