Actinomycosis is a disease caused by an anaerobic bacteria called Actinomyces species (predominantly Actinomyces israelii), which is a common and normally nonpathogenic organism found in the nose and throat. The four major clinical presentations of actinomycosis include the cervicofacial, thoracic, abdominal, and pelvic region. Actinomycosis is difficult to diagnose because of variable presentation and fastidious nature of the organism in culture. A high index of suspicion and biopsy are often necessary to make the diagnosis, because the disease can mimic neoplasm or a chronic granulomatous infection. We present, with the appropriate review, a case of actinomycosis in the mandibular angle area which was mistaken for a parotid abscess.
Abscess* ; Actinomyces ; Actinomycosis ; Actinomycosis, Cervicofacial ; Bacteria, Anaerobic ; Biopsy ; Diagnosis ; Nose ; Pelvis ; Pharynx

BACKGROUND AND OBJECTIVES: Hyper-responsiveness to nonspecific stimuli is a characteristic finding of all allergic diseases. It is probably due to eosinophil infiltration, release of cytotoxic proteins, and epithelial damage in the airway mucosa. However, the whole mechanism has not been clearly established. We aimed to understand the role of inducible nitric oxide synthase (iNOS) expression in nasal hyper-responsiveness of rhinosinusitis. MATERIALS AND METHOD: 1) To develop a platelet activating factor (PAF)-induced rhinosinusitis rat model, 50 micro liter of 16 micro gram/ml PAF was applied into the nose of rats. At days 1, 3 and 5, the rats were killed. 2) To demonstrate the hyper-responsiveness to topically applied capsaicin, 30 micro liter of 10 micro M capsaicin was applied intranasally and the amount of microvascular leakage in the nasal mucosa was measured with Evans blue assay at days 1, 3 and 5 in the rhinosinusitis model and the control rats. 3) To examine the effect of iNOS, 75 mg/kg of aminoguanidine was pretreated systemically 1 hour before the application of capsaicin. 4) To localize the expression of iNOS, immunohistochemical staining was performed using the avidin-biotin-peroxidase method with an anti-iNOS antibody. RESULTS: Induction of rhinosinusitis by application of PAF was confirmed with histology. A significant infiltration of eosinophils and loss of the epithelium, varied according to the time interval, were observed. A significant enhancement of microvascular leakage was clearly demonstrated by topically applied capsaicin, which was completely blocked by aminoguanidine, the iNOS inhibitor in the PAF-induced rhinosinusitis. The expression of iNOS was localized in the inflammatory cells infiltrated in the mucosa. CONCLUSION: The expression of iNOS in the inflammatory cells as well as epithelial damage related to eosinophil infiltration may cause nasal hyper-responsiveness.
Animals ; Capsaicin ; Eosinophils ; Epithelium ; Evans Blue ; Models, Animal* ; Mucous Membrane ; Nasal Mucosa ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II* ; Nose ; Platelet Activating Factor ; Rats* ; Sinusitis

BACKGROUND AND OBJECTIVES: Rhinosinusitis is a leading health care problem that is increasing in both prevalence and incidence. The current definition of chronic rhinosinusitis is symptom-based, as it is described as a disease lasting more than 12 weeks of presenting two or more major sinus symptoms or at least one major and two minor sinus symptoms with or without findings on physical exams. This study evaluated the usefulness of object testing such as endoscopy or computed tomography (CT) in the diagnosis of chronic rhinosinusitis. SUBJECTS AND METHOD: The study was designed to evaluate 44 patients who were diagnosed with chronic rhinosinusitis using the same-day endoscopy and CT scanning based on the foregoing definition. RESULTS: Of the 44 patients, 30 (68%) had positive endoscopic and CT results. There were 4 (9%) patients who gave negative endoscopic and positive CT results. Four (9%) patients had positive endoscopic and negative CT results, and 6 (14%) had negative endoscopic and negative CT results. Overall, 34 (77%) patients had positive CT results, and 10 (23%) patients had negative CT results. On the basis of CT as the standard, we determined that the positive predictive value of endoscopy was 88% and the negative predictive value of endoscopy 60%. The results of this study show that the definition of chronic rhinosinusitis needs to be called into question on the basis of endoscopic and CT results. CONCLUSION: We find that the use of endoscopy and/or CT scanning is important in making a more accurate diagnosis and planning appropriate treatment measures.
Adult* ; Delivery of Health Care ; Diagnosis* ; Endoscopes* ; Endoscopy ; Humans ; Incidence ; Prevalence ; Sinusitis ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis is a common etiology in olfactory dysfunction. There have been several studies regarding olfactory dysfunction in chronic rhinosinusitis using olfactory diagnostic tools, other than T & T olfactometer. To establish a relationship between the disease severity and severity of olfactory dysfunction, we evaluated the correlation between disease severity by using sinus CT scan as graded by the Harvard system and olfactory function by using the Butanol threshold test and T & T olfactometer. SUBJECTS AND METHOD: Fifty patients with chronic rhinosinusitis were evaluated. We scored each CT scan on the Harvard system, and the Butanol threshold test and T & T olfactemeter were performed for each patient. Correlation between the CT scores, Butanol test scores and T & T olfactometer scores was assessed. We also assessed for correlation between the 5 odorants used in the T & T olfactometer with the CT scores. RESULTS: The CT scores graded by the Harvard system and the score of Butanol threshold test was correlated significantly (p<0.01). The CT scores and the scores of T & T olfactometer, and those of each odorant used in the T & T olfactometer were correlated significantly (p<0.01). CONCLUSION: Using a T & T olfactometer, we found that disease severity is correlated with the severity of olfactory dysfuction. All odorants of T & T olfactometer were similarly correlated with the disease severity.
Humans ; Odors ; Sinusitis ; Smell ; Tomography, X-Ray Computed

Background: Propofol-based total intravenous anesthesia (TIVA) improves long-term outcomes after cancer surgery compared with inhalation anesthesia. However, its effect on patients undergoing non-small cell lung cancer (NSCLC) surgery remains unclear. We aimed to compare the oncological outcomes of TIVA and inhalation anesthesia after curative resection of early-stage NSCLC. Methods: We analyzed the medical records of patients diagnosed with stage I or II NSCLC who underwent curative resection at a tertiary university hospital between January 2010 and December 2017. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS) according to anesthesia type. Results: We included 1,508 patients with stage I/II NSCLC. The patients were divided into the TIVA (n = 980) and Inhalation (n = 528) groups. The two groups were well-balanced in terms of baseline clinical characteristics. The TIVA group demonstrated significantly improved RFS (7.7 years, 95% CI [7.37, 8.02]) compared with the Inhalation group (6.8 years, 95% CI [6.30, 7.22], P = 0.003). Similarly, TIVA was superior to inhalation agents with respect to OS (median OS; 8.4 years, 95% CI [8.08, 8.69] vs. 7.3 years, 95% CI [6.81, 7.71]; P < 0.001). Multivariable Cox regression analysis revealed that TIVA was an independent prognostic factor related to recurrence (hazard ratio [HR]: 1.24, 95% CI [1.04, 1.47], P = 0.014) and OS (HR: 1.39, 95% CI [1.12, 1.72], P = 0.002). Conclusions Propofol-based TIVA was associated with better RFS and OS than inhalation anesthesia in patients with stage I/II NSCLC who underwent curative resection.

PURPOSE: This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. MATERIALS AND METHODS: A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary's Hospital of the Catholic University of Korea, was included. They received 45-50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63-72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. RESULTS: After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. CONCLUSION: The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.
Adenocarcinoma ; Follow-Up Studies ; Humans ; Korea ; Male ; Multivariate Analysis ; Pelvis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy* ; Radiotherapy* ; Recurrence ; Seoul

Atypical antipsychotics, which have better efficacy and fewer side effects compared to first-generation antipsychotics, are being used increasingly for the treatment of schizophrenia. However, adverse events such as weight gain, diabetes mellitus and abnormal lipid profile have been reported in patients treated with these agents. Diabetic ketoacidosis (DKA) is a rare side effect of atypical antipsychotics, but deserves attention due to its severity. Although various atypical antipsychotics have been reported as causing DKA, there have been no reports showing an association with DKA and paliperidone, which is a recently developed antipsychotic agent. Here, we report two cases of DKA in patients with paliperidone therapy. Both cases had no history of diabetes before use of paliperidone, and DKA was manifested within 2 years of starting paliperidone therapy. Like other atypical antipsychotics, use of paliperidone warrants monitoring for metabolic derangements including DKA.
Antipsychotic Agents ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Humans ; Schizophrenia* ; Weight Gain

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a shortage of medical resources and the need for proper treatment guidelines for brain tumor patients became more pressing. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. As part II of the guideline, this consensus survey is to suggest management options in specific clinical scenarios during the crisis period. Methods: The KSNO Guideline Working Group consisted of 22 multidisciplinary experts on neuro-oncology in Korea. In order to confirm a consensus reached by the experts, opinions on 5 specific clinical scenarios about the management of brain tumor patients during the crisis period were devised and asked. To build-up the consensus process, Delphi method was employed. Results: The summary of the final consensus from each scenario are as follows. For patients with newly diagnosed astrocytoma with isocitrate dehydrogenase (IDH)-mutant and oligodendroglioma with IDH-mutant/1p19q codeleted, observation was preferred for patients with low-risk, World Health Organization (WHO) grade 2, and Karnofsky Performance Scale (KPS) ≥60, while adjuvant radiotherapy alone was preferred for patients with high-risk, WHO grade 2, and KPS ≥60. For newly diagnosed patients with glioblastoma, the most preferred adjuvant treatment strategy after surgery was radiotherapy plus temozolomide except for patients aged ≥70 years with KPS of 60 and unmethylated MGMT promoters. In patients with symptomatic brain metastasis, the preferred treatment differed according to the number of brain metastasis and performance status. For patients with newly diagnosed atypical meningioma, adjuvant radiation was deferred in patients with older age, poor performance status, complete resection, or low mitotic count. Conclusion It is imperative that proper medical care for brain tumor patients be sustained and provided, even during the crisis period. The findings of this consensus survey will be a useful reference in determining appropriate treatment options for brain tumor patients in the specific clinical scenarios covered by the survey during the future crisis.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the need for appropriate treatment guidelines for patients with brain tumors was indispensable due to the lack and limitations of medical resources. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. Methods: The KSNO Guideline Working Group was composed of 22 multidisciplinary experts on neuro-oncology in Korea. In order to reach consensus among the experts, the Delphi method was used to build up the final recommendations. Results: All participating experts completed the series of surveys, and the results of final survey were used to draft the current consensus recommendations. Priority levels of surgery and radiotherapy during crises were proposed using appropriate time window-based criteria for management outcome. The highest priority for surgery is assigned to patients who are life-threatening or have a risk of significant impact on a patient’s prognosis unless immediate intervention is given within 24–48 hours. As for the radiotherapy, patients who are at risk of compromising their overall survival or neurological status within 4–6 weeks are assigned to the highest priority. Curative-intent chemotherapy has the highest priority, followed by neoadjuvant/adjuvant and palliative chemotherapy during a crisis period. Telemedicine should be actively considered as a management tool for brain tumor patients during the mass infection crises such as the COVID-19 pandemic. Conclusion It is crucial that adequate medical care for patients with brain tumors is maintained and provided, even during times of crisis. This guideline will serve as a valuable resource, assisting in the delivery of treatment to brain tumor patients in the event of any future crisis.