BACKGROUND AND OBJECTIVES: Acute mastoiditis is an acute inflammatory disease of the mastoid process but it has declined dramatically in the postantibiotic era. However, contrary to the benefits of broad-spectrum antibiotics, resistant and unusual pathogens may cause this disease entity. Recently, in our hospital, antibiotic resistant and atypical pathogens such as Actinomyces, Mycobacterium tuberculosis were on the increase. In this paper we would like to discuss optimal diagnosis and treatment for acute mastoiditis. PATIENTS AND METHODS: Thirteen patients with mastoititis were treated in our hospital in the last 10 years. All of them were reviewedretrospectively. RESULTS: Eight patients recovered after treating with intravenous antibiotics with or without myringotomy and the rest were managed surgically. Among the 5 who received surgical treatments, one developed chronic otitis media and one developed cholesteatoma 3 years later. CONCLUSION: Surgical intervention was indicated for cases that accompanied complications. It would be important to be aware of any unusual pathogens in the management of acute mastoiditis which does not respond to empirical antibiotics therapy.
Actinomyces ; Anti-Bacterial Agents ; Cholesteatoma ; Diagnosis ; Humans ; Mastoid* ; Mastoiditis* ; Mycobacterium tuberculosis ; Otitis Media

BACKGROUND AND OBJECTIVES: Prognostic information is essential for the evaluation, judgement and optimal treatment of patients with head and neck squamous cell carcinoma. To evaluate the biological behavior of the malignancy, in particular, the proliferative activity of tumor cells were analyzed by proliferative markers, such as the Ki-67 index, PNCA and AgNOR. We performed this study to draw correlations between clinical findings and histopathologic prognostic factors using the Ki-67 index in the tumor tissues and the tumor adjacent epithelia. MATERIALS AND METHODS: The Ki-67 index of tumor tissues and the tumor adjacent epithelia from 24 patients with head and neck squamous cell carcinoma were analyzed using immunohistochemical methods. The relationships between the Ki-67 index in tumor tissues and tumor adjacent epithelia and several host and tumor factors were analyzed. RESULTS: The median Ki-67 index was higher in the tumor tissues than in the tumor adjacent epithelia (p<0.001). The ki-67 index of tumor tissues or tumor adjacent epithelia was not correlated with any host or tumor factor except N stage with tumor of interval to any treatment failure among the five variables which includes Ki-67 index, T stage, N stage, AJCC stage and age. Media interval to any treatment failure was shorter in groups with a high Ki-67 index than in groups with a low Ki-67 index of tumor tissue, but this result was statistically insignificant. CONCLUSION: The Ki-67 index was of little values in prognosis. However, among the various markers such as, the Ki-67 index, T stage, N stage, AJCC stage and age, the Ki-67 index of tumor tissue was the most significant predictor of interval to any treatment failure.
Carcinoma, Squamous Cell* ; Head and Neck Neoplasms ; Head* ; Humans ; Neck* ; Prognosis ; Treatment Failure

BACKGROUND: Smoking and high-risk occupation have been known to be the risk factors of lung cancer. The carcinogen-metabolizing enzymes in human body such as glutathione S-transferase M1, T1 and N-acetyltransferase 1 have also been regarded as risk factors in many cancers, because the activities of those enzymes play a role in metabolizing the carcinogen. A case-control study was conducted to evaluate the genetic polymorphism of GSTM1, T1 and NAT1 in lung carcinogenesis in Korean men. METHODS: The histologically proven lung cancer cases were recruited from Seoul National University Hospital. The patients of more than 40-year-old with the nonmalignant urinary tract diseases were recruited as controls from the same hospitals. The informations of demographical characteristics and smoking were obtained by interview or chart review and the genetic polymorphisms of GSTM1, T1 and NAT1 were determined by PCR-based assay. The statistical analyses were performed by linear logistic regression. RESULTS: The number of case-control was 118 and 150, respectively. The smoking history was significantly higher in the lung cancer patients than the controls. The prevalence of GSTM1 null-type was statistically higher(OR=2.25 ; 95% C I=1.12-4.51) in squamous cell carcinoma than other genotypes, but other histologic types were not. The prevalence of GSTT1 null-type were not statistically higher than other genotypes in all histologic types. The fast acetylator of NAT1 was more prevalent than normal(OR-2.13 ; 95% C I=1.04-4.40) in all lung cancer patients. CONCLUSION: The null-type of GSTM1 and fast acetylator of NAT1 are associated with development of lung cancer in Korean men.
Adult ; Carcinogenesis ; Carcinoma, Squamous Cell ; Case-Control Studies ; Genotype ; Glutathione Transferase* ; Glutathione* ; Human Body ; Humans ; Logistic Models ; Lung Neoplasms* ; Lung* ; Male ; Occupations ; Polymorphism, Genetic* ; Prevalence ; Risk Factors ; Seoul ; Smoke ; Smoking ; Urologic Diseases

Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.
Abdominal Pain ; Acute Kidney Injury ; Anuria ; Creatinine ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Fibrinogen ; Humans ; Hyalin ; Kidney ; Leiomyoma* ; Necrosis* ; Outpatients ; Peritoneal Dialysis, Continuous Ambulatory ; Prothrombin Time ; Ultrasonography ; Uterine Hemorrhage

Metastatic malignant tumors involving the thyroid gland are not as unusual as was once believed. They may in fact be more common than primary cancer of the thyroid, especially if careful screening is performed at autopsy. The origins of primary neoplasms that metasta size to the thyoid are myriad, but reports obviously indicate predminantly cancers of the kidney, breast, and lung and malignant melanoma. Occasienally, metastatic lesions from several gastrointestinal neoplasms such as colo-retal and esophageal carcinoma are seen, but metastasis from gastric cancer is very rare. We have seen one case of thyroid cancer metastasized from the stomach cancer. It simultaneously spread to the breast also and confirmed with gastrofiberscopic biopsy, fine needle aspiration cytology of the thyroid and excisonal biopsy of the breast. We report this case with reriew of literature.
Autopsy ; Biopsy ; Biopsy, Fine-Needle ; Breast* ; Gastrointestinal Neoplasms ; Kidney ; Lung ; Mass Screening ; Melanoma ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Thyroid Gland* ; Thyroid Neoplasms

It is known that there are numerous chemotatic secretoneurin -immunoreactive nerve fibers and movable MHC class II -immunoreactive dendritic cells in the normal uterine cervix. And the relationships between them are not fully understood. The aim of this study is to reveal that secretoneurin could give to chemotatic influence to dendritic cells in inflammational state. Virgin female Sprague -Dawley rats (n = 20; approximately 2 months old; 200 ~250 g body weight) were used in this study. Animals (n = 10) were injected with 5% formalin (0.5 ml/day, 5 days) in experiment group. Animals were deeply anesthetized with 3.5% chloral hydrate (100 mg/kg, i.p.) and uterine cervix were removed. Immunostaining was done according to standard methods used routinely. In brief, tissue sections were incubated with primary antibodies generated in mouse anti -rat MHC class II antibody and mouse or rabbit anti -rat secretoneurin antibody for single and double immunostains. FITC for secretoneurin and rhodamine for MHC class II were used as secondary antibodies in double stains. Tissue sections were observed by using light and confocal laser scanning microscopes. The results were as follows; 1. Numerous secretoneurin -immunoreactive nerve fibers were located in the lamina propria and those were not found in the epithelium of normal rat uterine cervix. 2. MHC class II -immunoreactive dendritic cells were mainly located in the epithelium and the lamina propria of normal rat uterine cervix. 3. On the inflammation state, MHC class II -immunoreactive dendritic cells were mainly located in the lamina propria and those were not found in the epithelium of rat uterine cervix. According to above results, it is suggested that secretoneurin can give to chemotatic influence to dendritic cells in inflammational state. Therefore, secretoneurin is considered to be used for dendritic cell immunotheraphy.
Animals ; Antibodies ; Cervix Uteri ; Chloral Hydrate ; Coloring Agents ; Dendritic Cells ; Epithelium ; Female ; Fluorescein-5-isothiocyanate ; Formaldehyde* ; Humans ; Infant ; Inflammation ; Mice ; Mucous Membrane ; Nerve Fibers ; Rats* ; Rhodamines ; Uterus*

OBJECTIVES: After the investigation of one worker with occupational asthma, we surveyed the prevalence of occupational asthma and the exposure level of pharmaceutical dust of 32 workers in a pharmaceutical company. METHODS: Thirty-two of the 90 employees participated in the survey which consisted of questionnaire, blood sampling, spirometry and skin prick tests with 8 common allergens as well as 9 antibiotics and 2 enzymes. Various indices of the working environment were also measured. Subjects who had a symptom suggestive of work-related asthma or positive skin prick test were further investigated by PC20 methacholine. Nine subjects who had a PC20 result of 16 mg/ml or less (n=7) or had work-related symptoms and positive skin prick test (n=2) were referred to undergo a specific bronchial provocation test to pharmaceutical dust in an academic allergic disease center. RESULTS: Eleven of 32 workers (34.4%) had a work-related symptom suggestive of occupational asthma. Ten (31.2%) showed positive skin prick test. 8 (25.0%) had a PC20 result of 16 mg/ml or less (indicative of significant bronchial hyperresponsiveness), and 5 (15.6%) had a positive result on the specific bronchial provocation test. Exposure levels of stuffing, input of raw materials and screening process were relatively high. CONCLUSIONS: This survey showed that pharmaceutical workers have an increased risk of occupational asthma. Although pharmaceutical factories maintain a relatively good working environment, careful control of respiratory tract exposures, especially during stuffing, input of raw materials and screening process, is important to prevent occupational asthma. Pharmaceutical workers need to undergo regular skin prick and methacholine bronchial provocation tests, as well as asthmatic symptom survey, to ensure the early detection and prevention of occupational asthma.
Allergens ; Anti-Bacterial Agents ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Dust* ; Mass Screening ; Methacholine Chloride ; Prevalence* ; Questionnaires ; Respiratory System ; Skin ; Spirometry

OBJECTIVES: Aims were to evaluate foot deformity in patients with rheumatoid arthritis for its types, prevalence, and relation with duration of the disease. METHODS: Inspection, measuring of hallux valgus and calcaneal angle and footprint were done on 256 feet of 128 patients with rheumatoid arthritis. Transverse (metatarsal) arch and longitudinal arch were evaluated by foot printings. RESULTS: 1) The most common type of foot deformities was hallux valgus in 175 of 256 feet(68.4%). Depressed transverse arches were in 169(66.0%), toe deformities including claw toe, hammer toe, curl toe and mallet toe in 125(48.9%), calcaneal valgus in 87(34.0%), callus in 67(26.2%), pes planus in 37(14.5%), and bunion in 25 (9.8%) of 256 feet. 2) Foot involvements as the initial manifestation were seen in 41 (32.0%) of 128 patients with rheumatoid arthritis. A duration of rheumatoid arthritis over 10 years were seen in 37 of 128 patients. In this patients mean number of involved toes per foot was 2.78 which was not statistically significant increase compared to that of all patients, 2.23 (p-value>0.05). Even with absence of foot symptoms in 28 of 128 patient with rheumatoid arthritis, toe deformities were seen in 1.55 toes per foot. And prevalence of hallux valgus, pes planus, depressed transverse arch and calcaneal valgus were 58.9%, 10.7%, 51.8% and 39.3% respectively. CONCLUSIONS: Foot deformities in patients with rheumatoid arthritis were usually inevitable complication. Even in the patients who had no foot symptom, there were foot deformities. So, we think that physicians should pay attention to the foot in all rheumatoid arthritis.
Arthritis, Rheumatoid* ; Bony Callus ; Congenital Abnormalities ; Flatfoot ; Foot Deformities ; Foot* ; Hallux Valgus ; Hammer Toe Syndrome ; Humans ; Prevalence ; Toes

BACKGROUND: The cases of Methicillin-Resistant Staphylococcus aureus(MRSA) infection after middle ear surgery, most of which are thought to be hospital acquired infection, are increasing recently in our hospital. MRSA infection is apt to be long lasting and to bring many complications because MRSA is resistant to aminoglycosides and cephalosporin as well as methicillin. There are many reports that medical personnel have a role to transmit that organisms to other patients. OBJECTIVES: To find and eradicate infection source and transmission route are both essential because medical personnel who contact MRSA infected patients can be a continuing transmission route. MATERIALS AND METHODS: Bacterial cultures from the noses and hands of medical personnel working in the department of Otolaryngology of Korea University Hospital were done and ribotyping through Southern blot technique was used to compare and prove an identical strain of MRSA organism between medical personnel and patients. RESULTS: As a result of ribotyping with EcoRI and HindIII, one distinct subtype(type I) was identified to be shared between medical personnel and patients. Among 30 medical personnel, 10 were carriers of MRSA. Seven MRSA isolates from these 10 medical carriers and 18 from 30 isolates of otorrhea shared the same type I ribotype. CONCLUSION: This finding reveals that MRSA transmission could occur between medical personnel and patients. Medical personnel should be aware of their possible role as a relay-stay of transmission of pathogenic organisms and should give efforts to prevent it.
Aminoglycosides ; Blotting, Southern ; Ear, Middle* ; Hand ; Humans ; Korea ; Methicillin ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Nose ; Otolaryngology ; Ribotyping ; Staphylococcus

Heliminthic paramyosin is a multifunctional protein that not only acts as a structural protein in muscle layers but as an immune-modulatory molecule interacting with the host immune system. Previously, we found that paramyosin from Clonorchis sinensis (CsPmy) is bound to human complement C9 protein (C9). To analyze the C9 binding region on CsPmy, overlapping recombinant fragments of CsPmy were produced and their binding activity to human C9 was investigated. The fragmental expression of CsPmy and C9 binding assays revealed that the C9 binding region was located at the C-terminus of CsPmy. Further analysis of the C-terminus of CsPmy to narrow the C9 binding region on CsPmy indicated that the region flanking731Leu–780 Leu was a potent C9 binding region. The CsPmy fragments corresponding to the region effectively inhibited human C9 polymerization. These results provide a precise molecular basis for CsPmy as a potent immunomodulator to evade host immune defenses by inhibiting complement attack.