The obstructive sleep apnea syndrome can occur due to various etiologies in children. In otherwise healthy children, adenotonsillar hypertrophy is the leading cause of childhood obstuctive sleep apnea. Obstructive sleep apnea caused by adenotonsillar hypertrophy can lead to a variety of symptoms and sequelae such as behavioral disturbance, enuresis, failure to thrive, developmental delay, cor pulmonale, and hypertension. So if obstructive sleep apnea is clinically suspected, proper treatment should be administered to the patient after diagnostic examinations. More than 80% improvement is seen in symptoms of obstructive sleep apnea caused by adenotonsillar hypertrophy in children after tonsillectomy and adenoidectomy. However, when it is impossible to treat the patient using surgical methods or residual symptoms remained after tonsillectomy and adenoidectomy, additional treatments such as weight control, sleep position change, and continuous positive airway pressure (CPAP), should be considered. This paper reports a case using weight control and Auto-PAP to control mild sleep apnea and snoring, which in long-term follow-up were not resolved after tonsillectomy and adenoidectomy for severe obstructive sleep apnea.
Adenoidectomy ; Adenoids ; Child ; Continuous Positive Airway Pressure ; Enuresis ; Failure to Thrive ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy ; Palatine Tonsil ; Pulmonary Heart Disease ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Tonsillectomy

Bilateral vestibulopathy (BV) is a clinical entity with impaired function of bilateral peripheral vestibular system, which is characterized by movement-induced vertigo, oscillopsia and gait unsteadiness. Among various etiologies of BV, alcohol and vitamin B deficiency has rarely been reported. We experienced a case of BV with vitamin B deficiency in a 24-year-old man who was previously exposed to alcohol. He had osillopsia and gait unsteadiness as a primary symptom, and was treated successfully with vestibular rehabilitation and vitamin supplement. Bithermal caloric test, rotatory chair test and head impulse test showed the result compatible with BV.
Alcoholism ; Alcohols ; Avitaminosis ; Caloric Tests ; Gait ; Head Impulse Test ; Humans ; Rehabilitation ; Vertigo ; Vitamin B Deficiency ; Vitamins ; Young Adult

For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.
Anesthesia ; Decompression ; Ear, Middle ; Facial Nerve ; Humans ; Male ; Mastoid ; Middle Ear Ventilation ; Minimally Invasive Surgical Procedures ; Paralysis ; Skin

Rare cases of lung adenocarcinoma (LUAD) with concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation have been reported. However, their clonal and evolutional relationship remains unclear. We report a case of early-stage EGFR-mutated LUAD with a focal concomitant EGFR/ALK alteration. A 63-year-old male underwent lobectomy to remove a 1.9-cm-sized lung nodule, which was diagnosed with EGFR-mutated LUAD. ALK immunohistochemistry (IHC) showed focal positivity within the part of the tumor characterized by lepidic pattern, also confirmed by fluorescence in-situ hybridization (FISH). Targeted next-generation sequencing was performed separately on the ALK IHC/FISH-positive and -negative areas. EGFR L833V/L858R mutations were detected in both areas, whereas EML4 (echinoderm microtubule-associated protein-like 4)-ALK translocations was confirmed only in the ALK IHC/FISH-positive area, suggesting the divergence of an EGFR/ALK co-altered subclone from the original EGFR-mutant clone. Our study suggests that concurrent alterations of EGFR and ALK can arise via divergent tumor evolution, even in the relatively early phases of tumorigenesis.

OBJECTIVES: Asia sand dust (ASD) is known to cause various human diseases including respiratory infection. The aim of this study was to examine the effect of ASD on inflammatory response in human middle ear epithelial cells (HMEECs) in vitro and in vivo. METHODS: Cell viability was assessed using the cell counting kit-8 assay. The mRNA levels of various genes including COX-2, TNF-a, MUC 5AC, MUC 5B, TP53, BAX, BCL-2, NOX4, and SOD1 were analyzed using semiquantitative realtime polymerase chain reaction. COX-2 protein levels were determined by western blot analysis. Sprague Dawley rats were used for in vivo investigations of inflammatory reactions in the middle ear epithelium as a result of ASD injection. RESULTS: We observed dose-dependent decrease in HMEEC viability. ASD exposure significantly increased COX-2, TNF-a, MUC5AC, and MUC5B mRNA expression. Also, ASD affected the mRNA levels of apoptosis- and oxidative stress-related genes. Western blot analysis revealed a dose-dependent increase in COX-2 production. Animal studies also demonstrated an ASD-induced inflammatory response in the middle ear epithelium. CONCLUSION: Environmental ASD exposure can result in the development of otitis media.
Animals ; Asia ; Asian Continental Ancestry Group* ; Blotting, Western ; Cell Count ; Cell Survival ; Cyclooxygenase 2 ; Dust* ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gene Expression* ; Humans ; In Vitro Techniques ; Mucins* ; Otitis Media ; Polymerase Chain Reaction ; Rats, Sprague-Dawley ; RNA, Messenger

OBJECTIVES: Fish vitellogenin (VTG) is produced in the female liver during oogenesis through the estradiol cycle and produced in the male liver by endocrine disrupting chemicals (EDCs) such as alkylphenols. In this study, we propose that the VTG concentration in the pale chub could be detected using monoclonal antibodies and polyclonal antibodies against vitellin (Vn) in a VTG enzyme-linked immunosorbent assay (ELISA) system. METHODS: Monoclonal antibodies and polyclonal antibodies were produced using the Vn extracted from the matured ovum of the ovary. The VTG was extracted from the plasma of the male pale chub. The Vn and VTG were confirmed by measuring the molecular weight of their proteins using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and the specificity of the antibodies was checked through western blotting methods. The assay system was validated with respect to optimal assay concentrations, specificity, recovery, and intra- and inter-assay variations. RESULTS: The Vn consisted of two protein bands with apparent molecular weights of 64 and 37 kDa. The SDS-PAGE indicated protein weights of 146 and 77 kDa in the VTG. The assay range was 15.6 ng/mL to 2,000 ng/mL, and the value of the intra- and inter-assay variations were within 10.0% and 14.7%, respectively. The recovery rate was 99.5+/-5.5%. CONCLUSIONS: A sandwich ELISA was developed that could be used to qualify the VTG of pale chub in screening for EDCs. Pale chub is an ideal species for observing estrogen activity in the environment because of its extensive habitat and extensive food chain. The ELISA developed here would be more favorable than those for other species for determining the effect of long-term food chain accumulation of EDCs in aquatic environments.
Antibodies ; Antibodies, Monoclonal ; Blotting, Western ; Cyprinidae* ; Ecosystem ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Endocrine Disruptors ; Enzyme-Linked Immunosorbent Assay* ; Estradiol ; Estrogens ; Female ; Food Chain ; Humans ; Liver ; Male ; Mass Screening ; Methods ; Molecular Weight ; Oogenesis ; Ovary ; Ovum ; Plasma ; Platypus* ; Sensitivity and Specificity ; Sodium ; Vitellins* ; Vitellogenins* ; Weights and Measures

Rituximab, a chimeric anti-CD20 IgG1 monoclonal antibody, has been used as a rescue therapy for steroid-dependent or refractory nephrotic syndrome. However, the adverse effects of rituximab are yet to be investigated. We report a case of a 9-year-old boy with steroid-dependent nephrotic syndrome who developed Kikuchi-Fujimoto disease after several cycles of rituximab therapy. Kikuchi-Fujimoto disease is a benign, self-limited necrotizing histiocytic lymphadenitis of unknown etiology. In the present case, Kikuchi-Fujimoto disease developed when the peripheral blood B-cell count of the patient was at nadir, and the lesion regressed slowly but spontaneously after recovery of the B-cell count. To our knowledge, although the pathologic diagnosis of Kikuchi-Fujimoto disease was unavailable, this is the first report of Kikuchi-Fujimoto disease with clinical diagnosis as a possible adverse effect of rituximab.
Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Child ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Immunoglobulin G ; Lymphadenitis ; Nephrotic Syndrome ; Rituximab

BACKGROUND AND OBJECTIVES: In this study, we tried to study the criteria and characteristics of patients with noise-induced hearing loss by analyzing the pure tone audiogram such as "C5 dip" or "4 kHz notch". SUBJECTS AND METHOD: Out of 553 patients who complained of tinnitus and hearing loss, medical examination by interview, physical examination, hearing test, brain MRI and survey of tinnitus were performed from January 2010 to December 2012, targeting 81 patients who underwent pure tone hearing test. We analyzed the clinical characteristics of 81 patients with the exception of systemic disease or a history of otologic disease, conductive hearing loss, and vestibular schwannomas. Patients consisted of 70 men and 11 women (34 persons on both sides, 31 persons on right side, and 16 persons on left side), with an average of 48.1+/-12.9 years. 4 kHz notch-type sensorineural hearing loss was compared with contralateral hearing. RESULTS: The audiogram of 4 kHz notch was analyzed, and the results were as follows; 0.5 kHz (11.2+/-9.9 dB HL), 1 kHz (13.2+/-9.9 dB HL), 2 kHz (19.4+/-15.4 dB HL), 3 kHz (38.1+/-18.7 dB HL), 4 kHz (49.3+/-16.2 dB HL), 8 kHz (27.2+/-16.2 dB HL). Among all frequencies of 4 kHz notch audiogram, there was no significant hearing loss in 0.5 kHz and 1 kHz, but significant hearing loss was noted in higher frequencies (paired t-test, p>0.05). The contralateral ear showed a ski-slope hearing loss in about half of the patients. CONCLUSION: Remarkable points of the 4 kHz notch audiogram analysis, known as a typical characteristic of noise-induced hearing loss, were as follows; First, there was hearing loss of about 50 dB HL at 4 kHz. Second, the hearing threshold was improved to about 30 dB HL at 8 kHz. Third, the 4 kHz-notch audiogram showed a significant hearing loss in a high-pitched tone of over 2 kHz, but otherwise there were no significant hearing loss observed in 0.5 kHz and 1 kHz. Fourth, even if there were no symptoms, contralateral ear can still show the ski-slope type of hearing loss.
Brain ; Ear ; Ear Diseases ; Female ; Hearing Loss* ; Hearing Loss, Conductive ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Hearing Tests ; Hearing* ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Noise* ; Physical Examination ; Tinnitus

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (C) levels, dynamic range (DR), and electrode impedance values (EIVs) during the first year in cochlear implant users. SUBJECTS AND METHOD: The maps of 49 cochlear implant users (at least 1 year mapping), using the Nucleus device, were examined at the time of initial connection, and at 6 and 12 months post-initial stimulation. T levels, C levels, DR and EIVs were analyzed according to three frequency levels. RESULTS: During the first 6 months of implant use, C levels and DR increased significantly whereas T levels were stable. EIVs of current carrying electrodes decreased significantly from the connection to the 12-month visit. The changes of electrical stimulation levels did not differ among three frequency levels during the entire follow-up. CONCLUSION: During the first 6 months of implant use, C levels and DR increased significantly. Thus, an appropriate mapping in the first 6 month is critical to setup hearing capacity in implant users. The mapping should be performed under the best communication environment between the audiologist and the patient, and it makes correct setting of T levels from the initial connection period.
Auditory Threshold ; Cochlear Implants ; Electric Impedance ; Electric Stimulation ; Electrodes ; Hearing ; Humans ; Lifting ; Longitudinal Studies