PURPOSE: The authors would like to introduce two patients who presented with velopharyngeal inadequacy. We emphasize the importance of nasaopharyngeal endoscopy in evaluating the velopharyngeal function and the usefulness of biofeedback trial therapy. METHODS: Two patients visited our clinic due to velopharyngeal inadequacy. Both of the patients showed hypernasality, nasal emission and compensatory articulation such as glottal stop. During oral examination and nasopharyngeal endoscopy both showed no evidence of structural deformities. One inconsistently showed a small gap during articulation. The other showed a rather large gap during compensatory articulation. Both received a simultaneous biofeedback trial therapy using the nasopharyngeal endoscope. RESULTS: Both patients were successfully diagnosed and treated at once using biofeedback trial therapy with nasopharyngeal endoscopy. By giving direct visual feedback to the patient, they were both able to achieve complete velopharyngeal closure during production of 2~3 nonsence syllables and hypernasality was not detected in both of them. CONCLUSION: The authors were able to help patients with velopharyngeal inadequacy to have velopharyngeal closure through biofeedback trial therapy. The accurate evaluation of velopharyngeal function and the possibility of closure prevented unnecessary operations.
Biofeedback, Psychology ; Congenital Abnormalities ; Diagnosis, Oral ; Endoscopy ; Feedback, Sensory ; Humans ; Velopharyngeal Insufficiency

A 17-year-old girl with 12-year history of systemic lupus erythematosus (SLE) was presented with one month history of diplopia and headache. She had experienced acute cerebral infarction due to multiple cerebral arterial stenosis one year before, and fully recovered except right-side central facial nerve palsy. When she visited pediatric emergency room, ophthalmologic examination showed ophthalmoplegia of the left eye ball; limitation of medial gaze, supra-adduction and infra-adduction. Neurologic examination didn't show any newly developed neurologic defect. There was no newly developed intra-cranial lesion on the brain MRI. But, the brain MRI revealed irregularly enhanced thickened left medial rectus muscle, and that was compatible with orbital myositis. There was no definite evidence of infection or other autoimmune disease. Her condition responded to high dose intravenous methylprednisone therapy (1 g/day for 3 days) and continued oral prednisolone.
Adolescent ; Autoimmune Diseases ; Brain ; Cerebral Infarction ; Constriction, Pathologic ; Diplopia ; Emergency Service, Hospital ; Facial Nerve ; Female ; Headache ; Humans ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Neurologic Examination ; Ophthalmoplegia ; Orbit* ; Orbital Myositis* ; Paralysis ; Prednisolone

Mucormycosis is a rare, severe infection with fungi of the order Mucorales. It is usually found in immunocompromised patients with diabetic ketoacidosis, glucocorticosteroid use, neutropenia in the setting of malignancy, and burns. Rhinocerebral disease is the most common form of mucormycosis. Other major symptoms are pulmonary, cutaneous, gastrointestinal, and systemic dissemination. Successful treatment requires removal of the underlying risk factor, antifungal therapy with amphotericin B, and aggressive surgery. We present a case of gastric perforation due to mucormycosis with diabetic ketoacidosis and chronic pancreatitis, with a review of the literature.
Amphotericin B ; Burns ; Diabetic Ketoacidosis* ; Fungi ; Humans ; Immunocompromised Host ; Mucorales ; Mucormycosis* ; Neutropenia ; Pancreatitis, Chronic* ; Risk Factors

It has been recently reported that a considerable portion of diabetic patients with renal insufficiency show normoalbuminuria. As little is known about normoalbuminuric renal insufficiency in the Asian population, we examined its prevalence and clinical characteristics in Korean type 2 diabetic patients. We studied 562 patients with type 2 diabetes from Seoul National University Hospital. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula and the degree of albuminuria was evaluated by spot urine albumin-creatinine ratio. Of 562 patients, 151 (26.9%) patients had renal insufficiency (eGFR <60 mL/min/ 1.73m(2)). Among them, 44 (29.1%) patients had normoalbuminuria. After excluding the patients using renin-angiotensin system (RAS) inhibitors, the prevalence of normoalbuminuric renal insufficiency was 35.3% (18 of 51 patients). Compared with microand macroalbuminuric renal insufficiency, normoalbuminuric renal insufficiency was associated with the female predominance, shorter duration of diabetes, lower prevalence of diabetic retinopathy, and lower prevalence of using antihypertensive drugs except RAS inhibitors. The prevalence decreased progressively with an increase in the duration of diabetes and an increase in the severity of retinopathy. Normoalbuminuric renal insufficiency was prevalent in Korean type 2 diabetic patients. The association with a shorter duration of the diabetes and a lower prevalence of retinopathy suggests that it might be an early stage renal complication.
Aged ; Albuminuria/diagnosis ; Body Mass Index ; Diabetes Complications/*diagnosis ; Diabetes Mellitus, Type 2/ethnology/*pathology ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Diseases/complications/*etiology ; Korea ; Male ; Middle Aged ; Renal Insufficiency/complications/*etiology ; Renin-Angiotensin System ; Time Factors

BACKGROUND AND OBJECTIVES: Total laryngectomy has become a usual treatment for any advanced carcinoma of the larynx, but most patients who have undergone total laryngectomy have shown permanent disability in voice production. To solve this problem, studies of voice rehabilitation after total laryngectomy have been done. MATERIALS AND METHODS: We have developed an accurate method to measure the vocal tract shape along its length from magnetic resonance images acquired during the sustained phonation of Korean vowels by T-E shunt patients and normal subject. We estimated the accuracy of MRI and also compared the vocal tract spape of the normal and T-E shunt patients by comparing the first three formant frequencies estimated from MRI to those measured directly from speech data of the T-E patients and the normal subject. RESULTS: The length of T-E shunt patient's vocal tract is 17-18.5 cm. T-E shunt patients phonated strained voice. The length of resonant chamber of T-E shunt patients are shorter than that of the normal subject. The vocal tract is shortened during the phonation by T-E shunt patients. In cases of /e/ and /i/, front cavities are constricted while back cavities are shortened. The pseudoglottis of the T-E shunt patients is located at the region 14-15 cm from lip. CONCLUSION: Acoustic characteristics and vocal tract shapes of the T-E shunt patients are relatively similar to those of the normal subject. To achieve normal voice, reconstruction of pharyngeal and superior glottal resonant chamber will be desirable.
Acoustics ; Humans ; Laryngectomy* ; Larynx ; Lip ; Magnetic Resonance Imaging ; Phonation* ; Rehabilitation ; Voice

BACKGROUND: It is important to recognize rhabdomyolysis in clinical settings, because 10~30% of rhabdomyolysis patients develop acute renal failure as a complication and patients with such complication have risk of high mortality. Recently, there have been frequent reports about healthy people who developed rhabdomyolysis after heavy exercise, but few prospective studies on exercise-induced rhabdomyolysis have been reported. METHODS: To evaluate the degree of muscle cell necrosis during the regular combat-police training, we examined the level of creatine kinase, plasma myoglobin and bone scan in 173 combat-police before the training and on fourth day after the training. Average ambient temperature and humidity during the study were 25degrees C and 78%, respectively. RESULTS: From the laboratory findings, 98 out of 173 combat-police were diagnosed as having rhabdomyolysis. Upon regressional analysis, an increase in amount of exercise correlated with the elevation of the levels of plasma creatine kinase and myoglobin. Among variables related to rhabdomyolysis only the levels of myoglobin, aspartate aminotransferase were significantly elevated. The level of plasma creatinine was elevated along with the elevation of plasma myoglobin. Bone scan not only provided detailed information on the location and degree of muscle cell damage, but also could be of diagnostic value in patients whose creatine kinase had been normalized. CONCLUSION: In people who developed rhabdomyolysis after heavy exercise, the level of plasma creatinine was elevated along with the elevation of plasma myoglobin. So early diagnosis of rhabdomyolysis and early detection of acute renal failure may be useful with monitoring of plasma myoglobin level.
Acute Kidney Injury ; Aspartate Aminotransferases ; Creatine Kinase ; Creatinine ; Early Diagnosis ; Humans ; Humidity ; Mortality ; Muscle Cells ; Myoglobin ; Necrosis ; Plasma ; Rhabdomyolysis*

Severe physical injury is a leading cause of posttraumatic syndrome (PTS). This is to develop a biomarker-based diagnostic algorithm for posttraumatic syndrome (BioPTS) study. This is a 2-year longitudinal cohort study assessing patients who were hospitalized beginning in 2015 at Chonnam National University Hospital in Gwangju, Korea, after experiencing severe physical injuries. Baseline evaluations were made during the acute phase (within 1 month) of the physical injury and included extensive information on sociodemographic and clinical variables as well as a list of biomarkers. All participants will be followed up for 2 years, and the diagnostic and predictive validities of various biomarkers for PTS will be estimated. The BioPTS study will develop the most accurate models for the diagnosis and prediction of PTS, and will contribute to existing research regarding the complex relationships between severe physical injury and psychological issues.
Biomarkers ; Cohort Studies ; Diagnosis ; Gwangju ; Humans ; Jeollanam-do ; Korea

A diet habit, which is developed in childhood, lasts for a life time. In this sense, nutrition education and early exposure to healthy menus in childhood is important. Children these days have easy access to the internet. Thus, a web-based nutrition education program for children is an effective tool for nutrition education of children. This site provides the material of the nutrition education for children with characters which are personified nutrients. The 151 menus are stored in the site together with video script of the cooking process. The menus are classified by the criteria based on age, menu type and the ethnic origin of the menu. The site provides a search function. There are three kinds of search conditions which are key words, menu type and "between" expression of nutrients such as calorie and other nutrients. The site is developed with the operating system Windows 2003 Server, the web server ZEUS 5, development language JSP, and database management system Oracle 10 g.
Child ; Cooking ; Database Management Systems ; Food Habits ; Humans ; Internet

Purpose: Hereditary cancer syndrome means that inherited genetic mutations can increase a person's risk of developing cancer. We assessed the frequency of germline mutations using an nextgeneration sequencing (NGS)–based multiple-gene panel containing 64 cancer-predisposing genes in Korean breast cancer patients with clinical features of hereditary breast and ovarian cancer syndrome (HBOC). Materials and Methods: A total of 64 genes associated with hereditary cancer syndrome were selected for development of an NGS-based multi-gene panel. Targeted sequencing using the multi-gene panel was performed to identify germline mutations in 496 breast cancer patients with clinical features of HBOC who underwent breast cancer surgery between January 2002 and December 2017. Results: Of 496 patients, 95 patients (19.2%) were found to have 48 deleterious germline mutations in 16 cancer susceptibility genes. The deleterious mutations were found in 39 of 250 patients (15.6%) who had breast cancer and another primary cancer, 38 of 169 patients (22.5%) who had a family history of breast cancer (≥ 2 relatives), 16 of 57 patients (28.1%) who had bilateral breast cancer, and 29 of 84 patients (34.5%) who were diagnosed with breast cancer at younger than 40 years of age. Of the 95 patients with deleterious mutations, 60 patients (63.2%) had BRCA1/2 mutations and 38 patients (40.0%) had non-BRCA1/2 mutations. We detected two novel deleterious mutations in BRCA2 and MLH1. Conclusion NGS-based multiple-gene panel testing improved the detection rates of deleterious mutations and provided a cost-effective cancer risk assessment.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.