The Korean Society of Laryngology, Phoniatrics and Logopedics appointed a task force to establish clinical practice guidelines for the management of unilateral vocal fold paralysis (UVFP). These guidelines cover a comprehensive range of management-related factors, including the diagnosis and treatment of UVFP, and provide in-depth information based on current, up-to-date knowledge. Detailed evidence profiles are provided for each recommendation. The CORE databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers, using a predefined search strategy. When insufficient evidence existed, expert opinions and Delphi questionnaires were used to fill the evidence gap. The committee developed 16 evidence-based recommendations in six categories: initial evaluation (R1–4), spontaneous recovery (R5), medical treatment (R6), surgical treatment (R7–14), voice therapy (R15), and aspiration prevention (R16). The goal of these guidelines is to assist general otolaryngologists and speech-language pathologists who are primarily responsible for treating patients with UVFP. These guidelines are also intended to facilitate understanding of the condition among other health-care providers, including primary care physicians, nurses, and policy-makers.

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux disease (LPRD) is relatively common disease. N-acetyl cysteine (NAC) has both mucolytic and antioxidant effect, also may be beneficial in inflammatory airway diseases. The purpose of this study was to evaluate the efficacy and safety of inhaled NAC therapy in LPRD. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 525 LPRD patients at 12 medical centers. Finally 401 patients subjected to inhaled NAC therapy for 2 months were enrolled in the study. We analyzed the change of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) after use of NAC for 4 weeks and 8 weeks in addition to the patient's compliance of the treatment. RESULTS: The RSI score significantly decreased from 19.87±6.34 to 12.78±6.93 after 4 weeks and to 10.65±7.47 after 8 weeks. The RFS score also significantly decreased from 9.29±3.4 to 7.17±3.41 after 4 weeks and to 6.1±3.73 after 8 weeks (p<0.05). During the treatment periods, 42 patients (10.4%) reported to have 80 episodes of discomfort. Throat discomfort (33%) and nausea (28%) were most common complaints, but the duration of discomfort was usually less than 4 weeks. CONCLUSION: Inhaled NAC treatment is highly effective for the reduction of both subjective and objective findings in LPRD patients. This study will provide the evidence of new treatment option for patients with LPRD. However, further studies will be needs to assess the real effect of inhaled NAC therapy as a standard treatment regimen of LPRD.
Antioxidants ; Compliance ; Cysteine ; Cystine ; Humans ; Inhalation ; Laryngopharyngeal Reflux ; Medical Records ; Nausea ; Pharynx ; Retrospective Studies

PURPOSE: Acute lower respiratory infection (ALRI), which is frequently encountered in pediatric patients, is the leading cause of hospitalization. We aimed to identify particular cytokines that correlated with ALRI clinical characteristics. We also aimed to identify any differences in cytokines between respiratory syncytial virus (RSV)-related ALRI and non-RSV-related ALRI. METHODS: Cytokine levels were measured in the sera sampled from 103 pediatric patients diagnosed with ALRI and admitted to Seoul St. Mary's Hospital between May 2012 and April 2013. The correlations between cytokine levels and the length of hospitalization, the number of days with fever, body temperature, pulse rate, respiration rate, oxygen saturation upon admission, and duration of oxygen supplementation were analyzed. RESULTS: In children with ALRI, the level of interleukin (IL)-6, granulocyte-colony stimulating factor (G-CSF), and IL-10 were correlated with a higher body temperature on admission. In addition, the IL-8 level was correlated with pulse rate and respiration rate, and IL-1β level was related with oxygen saturation on admission. In children with RSV-related ALRI, the IL-6 was correlated the with duration of fever, and the IL-1β, IL-2, and IL-8 levels were related to pulse rate and respiration rate. In addition, the increase in interferon-gamma-inducible protein-10 (IP-10) level was correlated with a higher body temperature on admission and a longer duration of hospitalization in children with RSV-related ALRI. CONCLUSION: In children with ALRI, the levels of IL-6, IL-8, IL-1β, G-CSF, and IP-10 were correlated with its clinical features. In children with RSV-related ALRI, the IL-1β, IL-2, IL-6, IL-8, and IP-10 level was correlated with the severity of the disease.
Body Temperature ; Child* ; Cytokines* ; Fever ; Granulocyte Colony-Stimulating Factor ; Heart Rate ; Hospitalization ; Humans ; Interleukin-10 ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Oxygen ; Respiratory Rate ; Respiratory Syncytial Viruses ; Seoul

Asian-lineage H5 highly pathogenic avian influenza (HPAI) viruses have caused continuous outbreaks in poultry and wild birds. Development of rapid and accurate diagnostic methods is needed for preventing further spread of the virus and reducing the time required for eradication of the virus. We developed a low-density microarray for the rapid detection and identification of avian influenza virus subtypes H5, H7, and H9 and their pathotypes in a previous study. In the present study, we evaluated previously developed diagnostic microarray using avian influenza viruses isolated in Mongolia, including H5 HPAI viruses. All H5 HPAI viruses isolated in Mongolia were shown as H5-specific and highly pathogenic pattern in the microarray. H2, H3 and H12 viruses isolated in Mongolia used in this study did not show any H5, H7 and H9 patterns. These results indicated that this diagnostic microarray has enormous potential for the rapid subtyping and pathotyping of influenza viruses, including viruses isolated in Mongolia.
Animals ; Birds ; Disease Outbreaks ; Influenza in Birds* ; Mongolia* ; Orthomyxoviridae ; Poultry

PURPOSE: We evaluated the safety and effectiveness of the Magnetic Resonance-guided Focused Ultrasound (MRgFUS) with the ExAblate Conformal Bone System for the palliation of painful bone metastases. MATERIALS AND METHODS: Our Institutional Review Board approved this study, and all patients gave informed consent prior to enrollment. A total of six painful metastatic bone lesions in five patients were treated using MRgFUS with the ExAblate Conformal Bone System for pain palliation. The follow-up sessions were at 3 days, 2 weeks, 1, 2, and 3 months, and 1 year after treatment. Efficacy was evaluated by the changes in visual analog scale (VAS) scores. At 3-months and 1-year follow-ups, unenhanced computed tomography and contrast-enhanced MR imaging examinations were performed. All adverse events were assessed to evaluate treatment safety. RESULTS: All patients showed significant pain relief within 2 weeks. Two patients experienced complete pain reduction that lasted for 1 year. Two other patients showed pain relief measured as VAS scores of 2 and 4 on their last follow-up. Although the remaining patient had experienced significant pain relief in two lesions, the VAS score re-increased on his last follow-up. The size of the enhancing soft tissue mass in metastatic lesions decreased, and new bone formation was seen on follow-up images. Although adverse events were not serious, non-specific leg pain and second degree skin burn were noted. CONCLUSION: MRgFUS was demonstrated to be effective palliative treatment within 2 weeks in selected patients with painful bone metastases.
Adult ; Aged ; Bone Neoplasms/secondary/*therapy ; Contrast Media ; Female ; High-Intensity Focused Ultrasound Ablation/adverse effects/*methods ; Humans ; Magnetic Resonance Imaging, Interventional/*methods ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Pain ; *Pain Management ; *Palliative Care ; Prospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: We evaluated the safety and effectiveness of the Magnetic Resonance-guided Focused Ultrasound (MRgFUS) with the ExAblate Conformal Bone System for the palliation of painful bone metastases. MATERIALS AND METHODS: Our Institutional Review Board approved this study, and all patients gave informed consent prior to enrollment. A total of six painful metastatic bone lesions in five patients were treated using MRgFUS with the ExAblate Conformal Bone System for pain palliation. The follow-up sessions were at 3 days, 2 weeks, 1, 2, and 3 months, and 1 year after treatment. Efficacy was evaluated by the changes in visual analog scale (VAS) scores. At 3-months and 1-year follow-ups, unenhanced computed tomography and contrast-enhanced MR imaging examinations were performed. All adverse events were assessed to evaluate treatment safety. RESULTS: All patients showed significant pain relief within 2 weeks. Two patients experienced complete pain reduction that lasted for 1 year. Two other patients showed pain relief measured as VAS scores of 2 and 4 on their last follow-up. Although the remaining patient had experienced significant pain relief in two lesions, the VAS score re-increased on his last follow-up. The size of the enhancing soft tissue mass in metastatic lesions decreased, and new bone formation was seen on follow-up images. Although adverse events were not serious, non-specific leg pain and second degree skin burn were noted. CONCLUSION: MRgFUS was demonstrated to be effective palliative treatment within 2 weeks in selected patients with painful bone metastases.
Adult ; Aged ; Bone Neoplasms/secondary/*therapy ; Contrast Media ; Female ; High-Intensity Focused Ultrasound Ablation/adverse effects/*methods ; Humans ; Magnetic Resonance Imaging, Interventional/*methods ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Pain ; *Pain Management ; *Palliative Care ; Prospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Objective: To investigate the anti-obesity activity and the action mechanism of the roots of Adenophora triphylla var. japonica extract (ATE) in high-fat diet (HFD)-induced obese mice and 3T3-L1 adipocytes. Methods: The roots of Adenophora triphylla were extracted with 70% ethanol. To demonstrate the compounds, linoleic acid was analyzed by using gas chromatography; and the anti-obesity effects and possible mechanisms of ATE were examined in 3T3-L1 adipocytes and HFD-induced obese mice. Results: Treatment with ATE inhibited the lipid accumulation without cytotoxicity in 3T3-L1 adipocytes. Furthermore, 200 and 400 mg/kg ATE treatment significantly decreased the body weight gain, white adipose tissues (WATs) weight and plasma triglyceride level, while 100 and 200 mg/kg ATE treatment increased the plasma high-density lipoprotein cholesterol level in the HFD-induced obese mice, as compared with the HFD group. Treatment with 200 and 400 mg/kg ATE also lowered the size of adipocytes in adipose tissue and reduced the lipid accumulation in liver. ATE treatment showed significantly lower expression level of adipogenesis-related proteins, such as peroxisome proliferator-activated receptor γ, fatty acid binding protein (aP2), fatty acid synthase in 3T3-L1 adipocytes; and furthermore, decreased peroxisome proliferator-activated receptor γ, aP2, fatty acid synthase, sterol regulatory element binding protein-1c, and lipoprotein lipase mRNA expression levels in WAT of the HFD-induced obese mice. Conclusions: These results suggested that the ATE has an anti-obesity effect, which may be elicited by regulating the expression of adipogenesis and lipogenesis-related genes and proteins in adipocytes and WAT of the HFD-induced obese mice.

PURPOSE: Several studies have shown that viral respiratory infections induce more severe respiratory symptoms in atopic patients than in normal subjects. We attempted to investigate if there is any difference in the viral etiology, clinical manifestations, production of interleukin (IL)-8, and regulated on activation in normal T-cell expressed and secreted (RANTES) between atopic and non-atopic subjects with lower respiratory infections. METHODS: Sera and nasopharyngeal aspirates (NPA) were collected from 97 children with lower respiratory infections who were admitted to the pediatric ward. Seventy-one children were classified as atopic subjects. We detected respiratory viruses with multiplex reverse transcriptase-polymerase chain reaction in NPA and measured total immunoglobulin E (IgE) and specific IgE in sera. IL-8 and RANTES levels measured in sera by enzyme-linked immunosorbent assay, etiology, and clinical manifestations were compared between atopic and non-atopic subjects. Atopic patients were defined as having elevated specific IgE to more than one allergen or age-matched, high serum total IgE levels. RESULTS: Both serum IL-8 and RANTES levels were significantly higher in atopic than in non-atopic patients. There was no significant difference in viral etiology and clinical diagnosis between the two groups. The frequency of wheezing was higher in atopic than in non-atopic patients. CONCLUSION: Our study showed that both serum IL-8 and RANTES levels and the frequency of wheezing were significantly higher in atopic than in non-atopic patients. That suggests that chemokine responses to viral respiratory infection may be different between atopic and non-atopic patients and may be associated with a difference in clinical manifestation, such as wheezing, between the two groups. However, further prospective large-scaled studies are required to clarify our conclusion.
Chemokine CCL5 ; Child ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E ; Immunoglobulins ; Interleukin-8 ; Interleukins ; Respiratory Sounds ; Respiratory System ; Respiratory Tract Infections ; T-Lymphocytes

BACKGROUND: We applied the pediatric risk of mortality (PRISM) III score to study patients in a pediatric intensivecare unit (PICU), where children with various kinds of diseases were hospitalized. We analyzed whether this scoring system was useful to predict patient mortality in the PICU. METHODS: We retrospectively analyzed the medical records of patients hospitalized in a 5-bed PICU at a tertiary general hospital. Children who were transferred to other hospitals and remained under pediatric intensive care were excluded from this study. RESULTS: We studied a total of 105 children, which included 63 boys (60%) and 42 girls (40%). The mean age was 4.2 years (range 0-17 years). The children were admitted to the PICU for various conditions, including respiratory disease (31 children), neurological disease (30 children), congenital anomaly or neonatal disease (11 children), hemato-oncological disease (10 children), accident or poisoning (7 children), cardiovascular disease (5 children), sepsis (2 children), and the other miscellaneous diseases (9 children). The mean period of PICU stay was 9 days (range 2-66 days). Out of the 105 patients, 94 survived and 11 died. Thus, the mortality rate was calculated as 10.5%. PRISM III scores of the patients were between 0 and 38, with a mean +/- SD of 5.0 +/- 6.7. In comparison with previous studies on PICU patients with similar PRISM scores, the patients included in our study exhibited a higher mortality. The area under the curve for the prediction of mortality by PRISM III was 0.107. Among the variables included in PRISM III, Glasgow coma scale, pupillary light reflex, and platelet counts were associated with patient mortality. CONCLUSIONS: In a PICU with a wide spectrum of diseases, PRISM III was not a useful predictor of patient mortality.
Cardiovascular Diseases ; Child ; Glasgow Coma Scale ; Hospitals, General ; Humans ; Critical Care ; Intensive Care Units ; Light ; Medical Records ; Platelet Count ; Reflex ; Retrospective Studies ; Sepsis

Perforations that occur during colonoscopy are usually managed by surgical repair. When the patient's symptoms are mild and laboratory findings show minor abnormalities, a conservative treatment can be considered. Although an operation is the treatment of choice in patients with generalized peritonitis, in some selected patients, percutaneous abscess drainage can be an alternative to surgical intervention for drainage of deep-infected fluid collections or can act as a temporary measure until the patient becomes sufficiently stable for surgery. We report here on a 53-yr-old male patient who developed signs of localized peritonitis and had a pelvic abscess due to a colonic perforation after colonoscopy and was treated successfully by using percutaneous abscess drainage.
Abscess ; Colon ; Colonoscopy ; Drainage ; Humans ; Male ; Peritonitis