OBJECTIVES: Recurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol). METHODS: Seventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated. RESULTS: There was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05). CONCLUSION: HyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS.
Cicatrix ; Edema ; Ether ; Humans ; Hyaluronic Acid ; Incidence ; Postoperative Complications ; Wound Healing

PURPOSE: IgE is associated with allergic disease. However, insufficient research has been carried out regarding the levels of serum IgA in children with allergic disease. The purpose of this study was to evaluate the levels of serum immunoglobulin in Korean children with allergic disease and to identify significant correlations between such diseases and serum IgA levels. METHODS: We evaluated 338 children who visited the Pediatric Allergy Clinic, CHA Bundang Medical Center from March 2007 to July 2013. We assessed factors, such as sex, age, and family history of allergic diseases. Laboratory tests, including serum IgG, A, and M, total IgE, and specific IgE, were carried out on all patients. In addition, we compared serum IgA levels in allergic Korean children with normal reference ranges. RESULTS: The median (interquartile range) of serum IgA values was 31.1 mg/dL (14.3-50.6 mg/dL) in cases of food allergy and 44.3 mg/dL (25.7-94.2 mg/dL) in cases of atopic dermatitis. The serum IgA levels were lower in allergic Korean children aged 9-12 months and 25-72 months than in the normal mean reference values. Relationships between age and serum IgA levels were statistically significant in allergic children. CONCLUSION: Our study suggests that serum IgA levels might be lower in allergic children than in the normal mean reference values. In order to understand this mechanism, normal levels for IgA in Korean children must be determined.
Child* ; Dermatitis, Atopic ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin A* ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Reference Values

Background: Phthalates and bisphenol A (BPA) are endocrine-disrupting chemicals and may cause immunological disorders in children. Therefore, according to the region, we investigated urinary phthalates and BPA levels and the relationship between urinary phthalate, aeroallergen sensitization, and eosinophil count during the coronavirus disease 2019 pandemic. Methods: In total, 203 schoolchildren (134 residential and 69 industrial) aged 7–10 years were enrolled between July 2021 and July 2022. The BPA, metabolites of four high-molecularweight phthalates (Σ4HMWP) and three low-molecular-weight phthalates (Σ3LMWP), were measured in the urine samples. Total eosinophil count and transepidermal water loss (TEWL) were also measured along with the skin prick test. Results: The two groups had no differences in terms of BPA. The industrial group had significantly more plastic container usage, and there was a difference in the Σ3LMWP (P < 0.001) between the two groups but no difference in the Σ4HMWP (P = 0.234). The quartiles of urinary Σ4HMWP and Σ3LMWP (P < were not associated with the total eosinophil count, vitamin D level, or TEWL. After adjusting for cofactors, the quartiles of urinary Σ4HMWP and Σ3LMWP were significantly associated with total eosinophil count (P < 0.001) but not with aeroallergen sensitization or vitamin D. Conclusion Exposure to phthalates was significantly associated with eosinophil count but not with aeroallergen sensitization or vitamin D. Therefore, reducing the use of plastic containers may effectively prevent exposure to phthalates and reduce Th2 cell-mediated inflammation in children.

Pulmonary arteriovenous malformations (PAVMs) are direct communications between pulmonary arteries and pulmonary veins, resulting in right-to-left shunts that may cause cyanosis, dyspnea, and digital clubbing. Neurological complications such as intrace rebral hemorrhage or brain abscess may result from cerebral thrombosis or emboli. In most cases, they remain unrecognized until the late te enage years. Here, we report a case of a 6-year-old boy who presented with perioral cyanosis, digital clubbing, and dyspnea on exertion. A plain chest X-ray showed a focal nodular opacity in the right lower lobe (RLL), and a diagnosis of a large PAVM in the RLL was confirmed by chest computed tomography. A right lower lobe ctomy was successfully performed without any complications. Although their incidence in children is low, PAVMs should be suspected as a possible cause of cyanosis and dyspnea of non-cardiac origin, and should be treated promptly to prevent further neurological complications.
Arteriovenous Malformations ; Brain Abscess ; Child ; Cyanosis ; Dyspnea ; Hemorrhage ; Humans ; Incidence ; Intracranial Thrombosis ; Pulmonary Artery ; Pulmonary Veins ; Thorax

BACKGROUND: Hyperhomocysteinemia as a risk factor for cerebrovascular disease is well known. Our aim of this study was to demonstrate positive association between elevated homocysteine levels and cerebrovascular diseases in Koreans. METHODS: With a case-control design, 186 stroke (infarction 134, hemorrhage 52) patients, diagnosed by brain CT or MRI and 359 control patients were evaluated. We used multiple logistic regression analyses conditioned on the matching variables (sex, age, hypertension, DM, smoking, hyperlipidemia, hyperhomocysteinemia) and calculated odds ratio and 95% CIs. RESULTS: Multivariated adjusted odds ratios (OR) for cerebrovascular diseases associated with hypertension compared with normal blood pressure were 2.45 (95% CI, 1.16 to 5.15) in prehypertension and 3.33 (95% CI, 1.56 to 7.10) in stage 1 hypertension and 3.77 (95% CI, 1.32 to 10.74) in stage 2 hypertension. OR for cerebrovascular diseases associated with hyperhomocysteinemia compared with <10micromol/L were 2.06 (95% CI, 1.09 to 3.91) in 13.0 to 16.9micromol/L and 3.17 (95% CI, 1.70 to 5.90) in > or =17 micromol/L. CONCLUSION: Not only hypertension but also hyperhomocysteinemia was a significant risk factor for cerebrovascular diseases in Koreans.
Asian Continental Ancestry Group ; Blood Pressure ; Brain ; Case-Control Studies ; Hemorrhage ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Hyperlipidemias ; Hypertension ; Logistic Models ; Magnetic Resonance Imaging ; Odds Ratio ; Prehypertension ; Risk Factors ; Smoke ; Smoking ; Stroke

PURPOSE: The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. MATERIALS AND METHODS: Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710microgram). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. RESULTS: Symptom improvement for the menorrhagia (87.5%), dysmenorrhea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications included ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. CONCLUSION: UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.
Analgesics ; Anti-Bacterial Agents ; Dysmenorrhea ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Polyvinyl Alcohol ; Retrospective Studies ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

PURPOSE: Landmark indicators have not yet to be developed to detect the regression of cervical intraepithelial neoplasia (CIN). We propose that quantitative viral load and indicative histological criteria can be used to differentiate between atypical squamous cells of undetermined significance (ASCUS) and a CIN of grade 1. MATERIALS AND METHODS: We collected 115 tissue biopsies from women who tested positive for the human papilloma virus (HPV). Nine morphological parameters including nuclear size, perinuclear halo, hyperchromasia, typical koilocyte (TK), abortive koilocyte (AK), bi-/multi-nucleation, keratohyaline granules, inflammation, and dyskeratosis were examined for each case. Correlation analyses, cumulative logistic regression, and binary logistic regression were used to determine optimal cut-off values of HPV copy numbers. The parameters TK, perinuclear halo, multi-nucleation, and nuclear size were significantly correlated quantitatively to HPV copy number. RESULTS: An HPV loading number of 58.9 and AK number of 20 were optimal to discriminate between negative and subtle findings in biopsies. An HPV loading number of 271.49 and AK of 20 were optimal for discriminating between equivocal changes and obvious koilocytosis. CONCLUSION: We propose that a squamous epithelial lesion with AK of >20 and quantitative HPV copy number between 58.9-271.49 represents a new spectrum of subtle pathological findings, characterized by AK in ASCUS. This can be described as a distinct entity and called "regressing koilocytosis".
Biopsy* ; Cervical Intraepithelial Neoplasia ; Female ; Humans* ; Inflammation ; Logistic Models ; Methods ; Papilloma* ; Viral Load ; Viruses*

BACKGROUND: Airway hyperresponsiveness has been estimated by means of forced expiratory volume in 1 second(FEV1) through the methacholine inhalation challenge test(MIC). But it is difficult to do the forced expiratory maneuver for measuring FEV1 in children. It is relatively easy to measure peak expiratory flow rate(PEFR) by portable peak expiratory flow meter(PEFM). OBJECTIVE: The purpose of this study is to evaluate whether FEV1 by means of MIC could be appropriately replaced by the measurement of PEFR. METHOD: A total of 30 subjects aged from 7 to 15 years with recurrent cough were enrolled in this study. MIC was performed with stepwise cumulative dose and both FEV1 and PEFR were measured at each step. The study was discontiued at the point of 20% reduction of FEV1 from the baseline value. FEV1 and PEFR were measured after salbutamol was inhaled by nebulizer. RESULT: There were significant correlations with reduction rates(r1=0.59, P<0.05) and recovery rates(r2=0.60, P<0.05) between FEV1 and PEFR, respectively. The sensitivity, specificity, positive predictive and negative predictive value of PEFR(PC20-FEV1 and PC20-PEFR<8 mg/ml) were 63.6, 94.7, 87.8 and 81.8%, respectively(P<0.05). CONCLUSION: Although PEFR measurement by means of MIC revealed low sensitivity, high specificity and positive predictive value could be obtained. These results indicate that PEFR measurement by means of MIC may be useful for diagnosing the airway hyperresponsiveness in children, although it cannot be replaced completely.
Albuterol ; Child ; Cough ; Forced Expiratory Volume ; Humans ; Inhalation ; Methacholine Chloride ; Nebulizers and Vaporizers ; Peak Expiratory Flow Rate* ; Sensitivity and Specificity

PURPOSE:To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. METHODS:The participants of our study were 1,104 children who were admitted to Bungdang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. RESULTS:The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age > or =2 years, while in the RSV group, 19% were age > or =2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. CONCLUSION:hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children.
Asthma ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Leukocyte Count ; Metapneumovirus ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Retrospective Studies ; Viruses

BACKGROUND: Functional dyspepsia (FD) is a commonly encountered disturbance of gut function and has been shown to be associated with psychological disturbance such as depression and anxiety. Of particular importance to clinicians are the relationship between anger, alexithymia, and depression. In this study, we investigated anger, alexithymia, and depression in patients with functional dyspepsia. METHODS: Thirty patients who visited Wonkwang University Hospital from January 2001 to June 2001, were diagnosed with functional dyspepsia by a gastroenterologist and compared with 37 healthy control group. Medical investigation of FD including gastrofiberscopy, esophageal manometry, and ambulatory 24-hours intraesophageal reflux test were negative. All subjects were evaluated for depression, anxiety, anger and anger expression, and alexithymia. The measures included Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Spielberger State-Trait Anger Expression Scale (STAXI), and Toronto Alexithymia Scale (TAS). RESULTS: The FD patients reported significantly more symptoms of depression, more difficulty describing feeling to others in TAS, less anger-in and anger-out expression in STAXI than the control subjects. Depressive symptoms in FD were positively correlated with state anxiety, trait anxiety, alexithymia, state anger, trait anger, and anger-in expression. In multiple regression model, state anger and trait anxiety together accounted for 69.1% of the depression in FD. CONCLUSION: The FD patients reported more depressive symptoms, and the depressive symptoms were related to anxiety, anger and anger-in, and alexithymia. These finding lend support that FD is a syndrome in which biopsychosocial process and affect dysregulation may play a role in features of FD.
Affective Symptoms* ; Anger* ; Anxiety ; Depression* ; Dyspepsia* ; Humans ; Manometry