BACKGROUND AND OBJECTIVES: The clinical utility of otoacoustic emissions (OAEs) has been well established in childhood hearing screenings. As middle ear negative pressure prevails in normal children, and since all OAEs must be transmitted through the middle ear before they can be measured in the ear canal, OAEs can be affected by middle ear negative pressure. The purpose of this study is to elucidate the effect of middle ear negative pressure on the detectability of OAEs. MATERIAL AND METHODS: TEOAEs were recorded for 36 ears using click before & after tonsillectomy and, or adenoidectomy (T and, or A) operations. Before & after T and or A operations, DPOAEs were generated at six geometric mean frequencies between 1-6 kHz for two different groups, Group I (40 ears) and Group II (36 ears). Group I: 3(f2/f1) ratios (1.21, 1.22 and 1.23) were used at the fixed stimulus level (70-70 dB SPL). Group II:3 stimulus levels were used (70-70 dB SPL, 60-70 dB SPL and 30-40 dB SPL). RESULTS: The negative middle ear pressure attenuated low frequency emission more than high frequency emission. CONCLUSION: Negative middle ear pressure may increase false alarm. So pneumatic otoscopy and aural immittance testing should be utilized to predict the feasibility of applying OAEs in childhood hearing screening test.
Adenoidectomy ; Child ; Ear ; Ear Canal ; Ear, Middle* ; Hearing ; Humans ; Mass Screening ; Otoscopy ; Tonsillectomy

Aneurysmal ruptures associated with middle cerebral artery(MCA) anomalies, such as a duplicated MCA and an accessory MCA, are quite rare. The authors reviewed the clinical relevance and possible etiology of these anomalies.
Aneurysm ; Aneurysm, Ruptured ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Rupture*

BACKGROUND/AIMS: The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. METHODS: The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). RESULTS: The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). CONCLUSIONS HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.

Patients with complete tracheal transection present a considerable challenge to the anesthesiologist. A 38 year-old woman with complete tracheal transection above the aortic arch level due to blunt trauma was taken to the operating room for an attempt at tracheal repair. Anesthetic management was focused on the maintenance of the airway and adequate ventilation. Primary repair of the trachea was carried out under ventilation support via percutaneous cardiopulmonary support system. Until the disrupted trachea was exposed on the surgical field, ventilation was performed using a laryngeal mask. We discuss the anesthetic management strategies and the alternative mode of ventilation.
Adult ; Aorta, Thoracic ; Female ; Humans ; Laryngeal Masks ; Operating Rooms ; Trachea ; Ventilation

BACKGROUND: Recent data regarding the clinical epidemiologic characteristics of Mycoplasma pneumoniae pneumonia in Korean adults are insufficient. This study was conducted in order to compare epidemics in different ages and to identify the clinical characteristics in adults. MATERIAL AND METHODS: We investigated patients who visited Korea University Guro Hospital from January to December 2011 due to community acquired pneumonia and underwent mycoplasma antibody tests. M. pneumoniae pneumonia was diagnosed if mycoplasma antibody titer was > or =1:320 at any time, seroconversion or 4-fold rise was seen at convalescent phase. Patients under the age of 19 were classified as child and adolescent, otherwise adult. We investigated the number of monthly cases in all patients and reviewed the medical records of adult patients. RESULTS: A total of 249 young patients aged < or =18 years and 29 adults were diagnosed with M. pneumoniae pneumonia. Among young patients, 75.5% were concentrated in the 0-6 years age group and 58.6% of adults belonged to the 26-40 years age group. The number of young patients began to increase in July and continued to increase in December, while the number of adult patients began to increase in August and occurred continuously until December. The correlation coefficient of the epidemic trend between the two groups was 0.682 (P=0.015). Median age of adult patients was 33.3 years. Fever was observed in all patients and 25 patients (86.2%) complained of purulent sputum. The average white blood cell count was 7,066/mm3. The average values for aspartate aminotransferase, alanine aminotransferase, creatinine, and sodium were within the normal range. In chest X-ray study, ipsilateral lower patchy consolidation was found in 24 patients (82.8%). Twenty one adult patients (72.4%) were hospitalized. The mean duration of hospitalization was 7.3 days. Twenty three patients (79.3%) were initially treated with combinations of third generation cephalosporin and macrolide. Among them, five patients (17.2%) showed poor responses. Six cases (20.7%) were initially treated with quinolone, and treatment was maintained until the end without changing antibiotics. Development of cryptogenic organizing pneumonia occurred in one case and there was no occurrence of death. CONCLUSIONS: When M. pneumoniae pneumonia is epidemic among children and adolescents, it should also be suspected in adult patients with community-acquired pneumonia. Some patients showed poor responses to macrolide. Overall, it appears that additional studies are needed for evaluation of the effectiveness of macrolide in treatment of M. pneumoniae pneumonia in adults.
Adolescent ; Adult ; Aged ; Alanine Transaminase ; Anti-Bacterial Agents ; Aspartate Aminotransferases ; Child ; Creatinine ; Cryptogenic Organizing Pneumonia ; Fever ; Hospitalization ; Humans ; Korea ; Leukocyte Count ; Macrolides ; Medical Records ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Reference Values ; Sodium ; Sputum ; Thorax

BACKGROUND: Etiologies and clinical profiles of acute respiratory viral infections need to be clarified to improve preventive and therapeutic strategies. MATERIALS AND METHODS: A retrospective observational study at a single, university-affiliated center was performed to evaluate the respiratory viral infection etiologies in children compared to that in adults and to document the clinical features of common viral infections for adults from July 2009 to April 2012. RESULTS: The common viruses detected from children (2,800 total patients) were human rhinovirus (hRV) (31.8%), adenovirus (AdV) (19.2%), respiratory syncytial virus (RSV) A (17.4%), RSV B (11.7%), and human metapneumovirus (hMPV) (9.8%). In comparison, influenza virus A (IFA) had the highest isolation rate (28.5%), followed by hRV (15.5%), influenza virus B (IFB) (15.0%), and hMPV (14.0%), in adults (763 total patients). Multiple viruses were detected in single specimens from 22.4% of children and 2.0% of adults. IFA/IFB, RSV A/B, and hMPV exhibited strong seasonal detection and similar circulating patterns in children and adults. Adult patients showed different clinical manifestations according to causative viruses; nasal congestion and rhinorrhea were more common in hRV and human coronavirus (hCoV) infection. Patients with RSV B, hRV, or AdV tended to be younger, and those infected with RSV A and hMPV were likely to be older. Those with RSV A infection tended to stay longer in hospital, enter the intensive care unit more frequently, and have a fatal outcome more often. The bacterial co-detection rate was 26.5%, and those cases were more likely to have lower respiratory tract involvement (P = 0.001), longer hospital stay (P = 0.001), and higher mortality (P = 0.001). CONCLUSIONS: The etiologic virus of an acute respiratory infection can be cautiously inferred based on a patient's age and clinical features and concurrent epidemic data. Large-scale prospective surveillance studies are required to provide more accurate information about respiratory viral infection etiology, which could favorably influence clinical outcomes.
Adenoviridae ; Adult* ; Child ; Coronavirus ; Estrogens, Conjugated (USP) ; Fatal Outcome ; Humans ; Intensive Care Units ; Length of Stay ; Metapneumovirus ; Mortality ; Observational Study ; Orthomyxoviridae ; Respiratory Syncytial Viruses ; Respiratory System ; Retrospective Studies ; Rhinovirus ; Seasons

The frequency of multiple gastric cancers has recently been on the increase due to the development of improved diagnostic methods, such as endoscopy, chromoscopy, and pathological methods. To prevent relapse by a remnant cancer, it is critical to determine the surgical area after evaluating the entire synchronous multiple gastric cancer area using closed endoscopy and a radiological evaluation prior to surgery. There have been no prior reports of a diagnosis of quintuple gastric cancer before surgery, although; a diagnosis of quadruple gastric cancer has been previously reported. Here we describe a 65-year-old male patient who received a diagnosis of early quintuple gastric cancer by endoscopy before surgery.
Aged ; Endoscopy ; Humans ; Male ; Recurrence ; Stomach Neoplasms

Since oxidative stresses are involved in gastroenteritis and diarrhea, we investigated antioxidative and antidiarrheal activities of persimmon flesh extract (PFE) and persimmon calyx extract (PCE) in vitro and in vivo, respectively. PCE significantly scavenged 1,1-diphenyl-2-picrylhydrazyl hydrate and 2,2'-azinobis (3-ethylbenzthiazoline-6-sulfonic acid) from 500 microg/mL, although PFE was ineffective. In addition, PFE and PCE exhibited strong nitric oxide-scavenging effects from 1 microg/mL, in which PCE was superior to ascorbic acid (50 microM). Furthermore, PFE and PCE significantly inhibited FeCl3-induced lipid peroxidation as well as Cu2+/H2O2-induced protein oxidation from 10 microg/mL. In vivo charcoal-propulsion assay, in contrast to a negligible effect of PFE, treatment with PCE (160-500 mg/kg) markedly inhibited intestinal motility. The results indicate that extracts of persimmon, especially PCE, possess antioxidative, antiinflammatory and antidiarrheal activities. Therefore, it is suggested that persimmon extracts could be used for the relief of gastroenteritis and diarrhea.
Ascorbic Acid ; Biphenyl Compounds ; Diarrhea ; Diospyros ; Gastroenteritis ; Gastrointestinal Motility ; Lipid Peroxidation ; Oxidative Stress ; Picrates