No abstract available.
Amnion* ; Decidua* ; Female ; Humans*

According to the Jastreboff's neurophysiological model of tinnitus, if negative associations are attached to the tinnitus signal, tinnitus is perceived to be a threat or a danger and it activates the autonomic nervous and limbic systems. Consequently patient's awareness of tinnitus is heightened and so patient perceives it to be louder and more persistent. Jastreboff and Hazell started tinnitus retraining therapy (TRT) based on the neurophysiological model of tinnitus. The purpose of TRT is blocking tinnitus from activating the sympathetic nervous and limbic systems (habituation of reaction) and from reaching the cerebral cortex (habituation of perception). TRT is composed of two components directive counseling that tries to reclassify tinnitus into the meaningless stimuli and sound therapy that decreases the relative strength of the tinnitus signal. Physicians try to put patient's tinnitus into the territory of meaningless stimuli through retraining the brain (habituation of reaction). Because the brain habituates all unimportant stimuli, if habituation of reaction is fully achieved, habituation of perception will follow automatically. In most clinical results, clinical success rates of TRT approach or exceed 80% improvement. Early improvement can be achieved during the first few months, followed by additional progressive improvement. It should be recommended that the patient continue treatment at least 18 months.
Brain ; Cerebral Cortex ; Directive Counseling ; Humans ; Limbic System ; Tinnitus*

OBJECTIVES: Genetic hearing loss is highly heterogeneous and more than 100 genes are predicted to cause this disorder in humans. In spite of this large genetic heterogeneity, mutations in SLC26A4 and GJB2 genes are primarily responsible for the major etiologies of genetic hearing loss among Koreans. The purpose of this study is to investigate the genetic cause of deafness in Korean cochlear implantees by performing a genetic screening of the SLC26A4 and GJB2 genes. METHODS: The study cohort included 421 unrelated Korean patients with sensorineural hearing loss (SNHL) and who had received cochlear implants (CI) at Soree Ear Clinic from July 2002 to December 2010. Among 421 CI patients, we studied 230 cases who had received the genetic screening for SLC26A4 or GJB2 genes. Written informed consent was obtained from all participants. All patients had severe to profound, bilateral hearing loss. For 56 patients who showed enlarged vestibular aqueduct on their computed tomography (CT) scan, we analyzed SLC26A4. For 174 CT negative patients, GJB2 gene was sequenced. RESULTS: For the 56 SLC26A4 patients, 32 (57.1%) had two pathogenic recessive mutations in SLC26A4. A single recessive SLC26A4 mutation was identified in 14 patients (25%). H723R and IVS7-2A>G were the most commonly found mutations, accounting for 60.3% (47/78) and 30.8% (24/78) of the mutated alleles, respectively. For the 174 GJB2 patients, 20 patients (11.5%) had two pathogenic recessive mutations in GJB2. 235delC was the most common mutation, accounting for 43.0% (31/72) of mutant alleles. CONCLUSION: The two major genes, SLC26A4 and GJB2, contribute major causes of deafness in CI patients. Continuous studies are needed to identify new genes that can cause hearing loss to Korean CI patients.
Accounting ; Alleles ; Cochlear Implants ; Cohort Studies ; Connexins ; Deafness ; Ear ; Genetic Heterogeneity ; Genetic Testing ; Goiter, Nodular ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sensorineural ; Humans ; Informed Consent ; Vestibular Aqueduct

No abstract available.
Anemia, Pernicious* ; Osteoporosis*

Many cochlear implant recipients require magnetic resonance imaging (MRI). Cochlear implants (CI) have been contraindications to MRI, because of potential device displacement, generation of heat within the device and surrounding tissues and potential compromise of device integrity. The CI-MRI incompatibility has led to changes in the designing of CI. One approach has been to enable the magnet to be surgically removed before MRI. We report an experience of performing MRI on a cochlear implant recipient after magnet removal.
Cochlear Implants* ; Hot Temperature ; Humans ; Magnetic Resonance Imaging*

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.
Adenoidectomy ; Anesthesia ; Child ; Diclofenac* ; Fentanyl* ; Humans ; Pain, Postoperative ; Tonsillectomy*

Lipedema is a chronic disease of lipid metabolism that results in the symmetrical impairment of fatty tissue distribution and storage combined with the hyperplasia of individual fat cells. Lipedema occurs almost exclusively in women and is usually associated with a family history and characteristic features. It can be diagnosed based on clinical history and physical examination. Lipedema is usually symmetrical, but spares the feet, is often painful to palpation, and is negative for Stemmer's sign. Additionally, lipedema patients can present with microangiopathies and lipomas. The well-known therapies for lipedema include complex decongestive therapy, pneumatic compression, and diet modifications. However, whether these treatments help reduce swelling is debatable. We encountered a case of lipedema that was initially misdiagnosed as lymphedema. The patient's clinical features and history were different from those typical of lymphedema, prompting a diagnosis of lipedema and she was treated with a complex decongestive therapy program.
Adipocytes ; Adipose Tissue ; Chronic Disease ; Female ; Food Habits ; Foot ; Humans ; Hyperplasia ; Lipid Metabolism ; Lipoma ; Lymphedema ; Palpation ; Physical Examination ; Rare Diseases

OBJECTIVE: There is no data on which is more important for the intensity of intra-amniotic inflammation (IAI) between total grade or involved anatomical region in acute histologic chorioamnionitis (acute-HCA) of preterm-gestations. The objective of current study is to examine this issue. METHODS: The intensity of IAI was measured by amniotic fluid (AF) white blood cell (WBC) count and matrix metalloproteinase-8 (MMP-8) concentration in 225 singleton preterm-gestations (<36 weeks) who had acute-HCA including chorio-decidua involvement and delivered within 5 days of amniocentesis. Acute-HCA was defined in the presence of acute inflammatory changes in each anatomical region (i.e., chorio-decidua, amnion or chorionic plate). Patients were divided into 6 groups according to total grade (i.e., 1-6) and the presence or absence of chorio-decidua restriction (i.e., chorio-decidua restriction vs. extension beyond chorio-decidua) of acute-HCA. RESULTS: There was no significant difference in a median AF WBC and MMP-8 between the two groups (group-1, cases with total grade 1 vs. group-2, cases with total grade 2) among cases with chorio-decidua restriction (each for P>0.05) and between the four groups (group-3, cases with total grade 2 vs. group-4, cases with total grade 3 vs. group-5, cases with total grade 4 vs. group-6, cases with total grade 5-6) among cases with extension beyond chorio-decidua (each for P>0.05). However, group-3 (cases with extension beyond chorio-decidua) had a significantly higher median AF WBC and MMP-8 than group-2 (cases with chorio-decidua restriction) among cases with total grade 2 (each for P<0.05). CONCLUSION: Involved anatomical region is more important than total grade for the intensity of IAI in acute-HCA of preterm-gestations.
Amniocentesis ; Amnion ; Amniotic Fluid ; Chorioamnionitis ; Chorion ; Female ; Humans ; Inflammation ; Leukocytes ; Matrix Metalloproteinase 8 ; Pregnancy

Krukenberg tumor of the primary breast carcinoma is rare and this is almost invasive lobular carcinoma. They are usually bilateral and frequent in premenopausal women. Diagnosis of symptomatic Krukenberg tumor is reported to be 1 or 2 year after the diagnosis of primary neoplasm. But sometimes it is discovered prior to the detection of the primary breast carcinoma. Unexpected ovarian micrometastasis was recognized after oophorectomy of normally appearing ovaries in breast cancer patients. Existence of Krukenberg tumor means advanced primary disease and possible metastasis to other organs, and have a poorer prognosis. We report a case of Krukenberg tumors occurred 3 years after the diagnosis of primary ductal type breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Neoplasm Micrometastasis ; Ovariectomy ; Ovary* ; Prognosis

OBJECTIVE: To determine the frequency and clinical significance of intra-amniotic inflammation (IAI) defined as an elevated amniotic fluid (AF) matrix metalloproteinase-8 (MMP-8) concentration in patients with preterm labor and intact membranes (PTL) and low AF white blood cell (WBC) counts. METHODS: Adverse pregnancy outcomes were compared according to the presence or absence of IAI in 220 singleton gestations who underwent amniocentesis due to PTL (gestational age<35.7 weeks) and had low AF WBC counts (<19 cells/mm3). Adverse pregnancy outcomes included preterm birth within 5 days of amniocentesis, acute histologic chorioamnionitis (acute-HCA) and positive AF culture. IAI was defined as an elevated AF MMP-8 concentration (> or =23 ng/mL). RESULTS: IAI was present in 19% of study population. Adverse pregnancy outcomes were significantly more frequent in patients with IAI than in those without IAI (preterm birth within 5 days of amniocentesis, 88% vs. 41%; acute-HCA, 47% vs. 11%; positive AF culture, 10% vs. 2%; each for P<0.05). Patients with IAI had a significantly shorter median amniocentesis-to-delivery interval than those without IAI (7.8 hours [0.01-3,307.3 hours] vs. 310.3 hours [0.01-2,973.8 hours]; P<0.001 from survival analysis). Multiple logistic regression analysis demonstrated that only an IAI (odds ratio, 3.3; 95% confidence interval, 1.5-7.3; P<0.005) retained a statistical significance in the prediction of acute-HCA after other confounding variables were adjusted. CONCLUSION: Approximately one-fifth of patients with PTL and low AF WBC counts have an evidence of IAI and are at risk for impending preterm delivery and acute-HCA when AF MMP-8 concentration is used.
Amniocentesis ; Amniotic Fluid ; Chorioamnionitis ; Confounding Factors (Epidemiology) ; Female ; Humans ; Inflammation ; Leukocyte Count ; Leukocytes ; Logistic Models ; Matrix Metalloproteinase 8 ; Membranes ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Pregnancy Outcome ; Premature Birth