Osteomyelitis caused by maxillary sinusitis is clinically rare. We report a case of a 43-year-old woman who presented with an oroantral fistula on the hard palate, originating from osteomyelitis complicated by maxillary sinusitis. To our knowledge, oroantral fistula on the hard palate caused by chronic rhinosinusitis is rare. Physical, radiological, and cytological findings revealed the clues suggesting osteomyelitis. We performed endoscopic sinus surgery for the sinus lesion and the fistula healed spontaneously after the procedure.
Adult ; Female ; Fistula ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; Oroantral Fistula ; Osteomyelitis ; Palate, Hard

Iatrogenic epidermoid cyst of the retroauricular area after ear surgery is extremely unusual. Epidermoid cyst is an intradermal or subcutaneous sac-like structure which is lined with well differentiated stratified squamous epithelium containing keratohyalin granules. These cysts are thought to arise as a result of implantation of epidermal cells into the deeper dermal elements by trauma or previous surgery. We report a 42-year-old female with retroauricular epidermoid cyst invading into the temporal bone who underwent tympanoplasty 15 years ago. The lesion was surgically excised, histopathologic examination revealed an epidermoid cyst. Therefore we report the case along with review of literature.
Adult ; Ear ; Epidermal Cyst ; Epithelium ; Female ; Humans ; Keratins ; Temporal Bone ; Tympanoplasty

Castleman's disease, or angiofollicular lymph node hyperplasia, is a rare disorder that involves the proliferation of lymphoid tissue. The disease entity is classified into three pathologic subtypes, namely, the hyaline vascular, plasma cell, and mixed types; however, clinically, they are classified as unicentric and multicentric types. The former is treated primarily by excision, whereas systemic therapies have been used to treat the latter form, because of its more aggressive pattern. We report a case of a 17-year-old woman who underwent an excisional biopsy of one of the multiple affected cervical lymph nodes. A subsequent histopathologic examination revealed hyaline vascular Castleman's disease. One month later, the disease spontaneously regressed and no recurrence was observed over a 12-month period following the excisional biopsy.
Adolescent ; Biopsy ; Female ; Giant Lymph Node Hyperplasia ; Humans ; Hyalin ; Lymph Nodes ; Lymphoid Tissue ; Lymphoproliferative Disorders ; Neck ; Plasma Cells ; Recurrence ; Remission, Spontaneous

Paget's disease is a localized bone disorder that affects widespread areas of skeleton characterized by increased bone remodeling. It is a chronic, progressive disease of unknown etiology. The pathologic process is initiated by hyperactive osteoclastic bone resorption followed by a compensatory increase in the osteoblastic new bone formation. New pagetic bones are disorganized and more susceptible to deformities and fractures. Paget's disease can affect one or multiple bones in the systemic skeleton, including the temporal bone. We experienced a case of chronic otitis media combined with an external auditory canal stenosis due to Paget's disease of the temporal bone. We report clinicopathologic features of this rare case.
Bone Remodeling ; Bone Resorption ; Congenital Abnormalities ; Constriction, Pathologic ; Ear Canal ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Otitis Media ; Skeleton ; Temporal Bone

BACKGROUND AND OBJECTIVES: Olfaction is a critical function of our body that allows one to avoid potential dangers in daily living. Although there are numerous subjective and objective tests evaluating the olfactory function, there exist no studies assessing correlations among such tests for various causes of olfactory dysfunction, especially in Korea. SUBJECTS AND METHOD: We collected the olfactory functional test results of 473 subjects who visited our outpatient clinic. We categorized these patients into 5 groups: head trauma, post-upper respiratory infection, chronic sinonasal disease, toxic exposure, and idiopathic. All patients were examined using the Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT). The patients' subjective symptoms were recorded using the Visual Analog Scale (VAS). RESULTS: The three tests showed significant correlations in different pairs (CC-SIT and BTT; r=0.512, p<0.001, BTT and VAS; r=0.558, p<0.001 and VAS & CC-SIT; r=0.567, p<0.001). Correlation results were lower in patients with olfactory disorders caused by an upper respiratory infection and head trauma than in those with olfactory disorders caused by sinonasal diseases. CONCLUSION: The results from all three tests showed significant correlations with one another. CC-SIT and VAS score seem to represent the olfactory loss caused by sensorineural dysfunction better than BTT.
Ambulatory Care Facilities ; Craniocerebral Trauma ; Humans ; Olfaction Disorders ; Smell

BACKGROUND: Nosocomial candidemia has increased over the past 2 decades. The rank order of occurrence and antifungal resistance profiles of the various species of Candida causing candidemia is important in establishing empiric treatment protocols. METHODS: We investigated antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-year period in Chonnam National University Hospital. The results obtained from the period 1994 through 1997 (period 1) were compared with those from the period 1998 through 2001 (period 2). Minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole and itraconazole for each isolate were determined by the NCCLS broth microdilution method. RESULTS: During an 8-year period, 805 strains of Candida species were isolated from 290 patients. In period 1, the Candida species recovered most frequently from candidemic patients was C.albicans(29.5%), followed by C. parapsilosis (25.9%) and C. tropicalis (18.8%). In period 2, C. parapsilosis (31.5%) was the most common species, followed by C. albicans (23.6%), and C.glabrata (14.0%). These data, compared to those of period 1, indicate a variation in species distribution, with the proportions of C. glabrata increasing by 10.0% (P<0.005). MIC50 of amphotericin B, fluconazole and itraconazole for each species did not change appreciably during the two periods. However, resistance to fluconazole (>or=64 microgram/mL) and itraconazole (>or=1 microgram/mL) was observed more frequently in period 2 (8.0% and 20.9%, respectively) than in period 1 (2.0% and 7.0%, respectively)(P<0.05). CONCLUSIONS: These data showed that MICs of amphotericin B, fluconazole and itraconazole for each species did not change during the 8-year span, but azole resistant Candida species such as C. glabrata, increased in the latter four years (period 2).
Amphotericin B ; Candida* ; Candidemia ; Clinical Protocols ; Danazol ; Fluconazole ; Humans ; Itraconazole ; Jeollanam-do

BACKGROUND: Nosocomial candidemia has increased over the past 2 decades. The rank order of occurrence and antifungal resistance profiles of the various species of Candida causing candidemia is important in establishing empiric treatment protocols. METHODS: We investigated antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-year period in Chonnam National University Hospital. The results obtained from the period 1994 through 1997 (period 1) were compared with those from the period 1998 through 2001 (period 2). Minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole and itraconazole for each isolate were determined by the NCCLS broth microdilution method. RESULTS: During an 8-year period, 805 strains of Candida species were isolated from 290 patients. In period 1, the Candida species recovered most frequently from candidemic patients was C.albicans(29.5%), followed by C. parapsilosis (25.9%) and C. tropicalis (18.8%). In period 2, C. parapsilosis (31.5%) was the most common species, followed by C. albicans (23.6%), and C.glabrata (14.0%). These data, compared to those of period 1, indicate a variation in species distribution, with the proportions of C. glabrata increasing by 10.0% (P<0.005). MIC50 of amphotericin B, fluconazole and itraconazole for each species did not change appreciably during the two periods. However, resistance to fluconazole (>or=64 microgram/mL) and itraconazole (>or=1 microgram/mL) was observed more frequently in period 2 (8.0% and 20.9%, respectively) than in period 1 (2.0% and 7.0%, respectively)(P<0.05). CONCLUSIONS: These data showed that MICs of amphotericin B, fluconazole and itraconazole for each species did not change during the 8-year span, but azole resistant Candida species such as C. glabrata, increased in the latter four years (period 2).
Amphotericin B ; Candida* ; Candidemia ; Clinical Protocols ; Danazol ; Fluconazole ; Humans ; Itraconazole ; Jeollanam-do

BACKGROUND: One of main mechanisms responsible for acquired azole resistance of Candida glabrata is the increased drug efflux mediated ABS transporters, which are encoded by CgCDR1 and CgCDR2 genes. OBJECTIVES: We compared real-time reverse transcriptase PCR (RT-PCR) with northern hybridization for quantitative analysis of CgCDR1 and CgCDR2 expression in bloodstream isolates of C. glabrata. METHODS: Nineteen blood isolates of C. glabrata were selected, including nine fluconazole susceptible (MIC < or =8 microgram/ml), nine susceptible dose-dependent (S-DD, MIC 16~32 microgram/ml), and one resistant (MIC 128 microgram/ml), isolates. The expression of CgCDR1 and CgCDR2 was quantified using real-time RT-PCR with ROTOR Gene 3000 (Corbettet research, Austria). The results were compared with northern hybridization with sequence-specific probes. RESULTS: Correlation of quantification results between real-time RT-PCR and northern hybridization yielded correlation coefficients of 0.92 for CgCDR1 and 0.82 for CgCDR2 gene. By both methods, no significant differences were observed in the levels of expression of CgCDR1 and CgCDR2 between fluconazole-susceptible isolates and S-DD isolates. In contrast, a strain with high fluconazole resistance (MIC 128 microgram/ml) revealed a greater abundance of CgCDR1 by both methods, compared to the other isolates. Conclusion: This study show that real-time PCR method for C. glabrata RNA quantification correlates well with traditional northern hybridization and can be a valuable alternative to northern hybridization for rapid quantification of CgCDR1 and CgCDR2 genes in clinical isolates of C. glabrata.
Candida ; Candida glabrata ; Chimera ; Danazol ; Fluconazole ; Gene Expression ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; Sprains and Strains

BACKGROUND: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. METHOD: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological barriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (from 5 points for 'very true' to 1 point for 'very untrue'). RESULTS: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 +/- 0.92, 3.17 +/- 0.98 and 2.8 +/- 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. CONCLUSION: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians.
Anxiety ; Counseling ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin ; Insulin Resistance ; Rejection (Psychology) ; Telephone ; Weight Gain ; Surveys and Questionnaires

BACKGROUND: Cardiac transplantation has been established as a treatment of choice for patients with end- stage heart failure. However, the experiences of cardiac transplantation are still limited in Korea. METHODS: Seventeen adult cardiac transplantations (13 males and 4 females) were performed in Seoul National University Hospital since March 1994. Clinical outcome & course, acute rejection, and complications among transplanted patients were reviewed. RESULTS: Underlying cardiac conditions leading to cardiac transplantation were dilated cardiomyopathy in 9, valvular heart disease with severe LV dysfunction after prosthetic valve replacement in 3, restrictive cardiomyopathy in 2, ischemic cardiomyopathy in 1, intractable ventricular tachyarrhythmia in 1 and hypertrophic cardiomyopathy with severe LV dysfunction in 1 patient. Ages of recipients were between 22 and 54 (median:38). Mean follow up duration was 27 months (1-45 months). The frequencies of rejection decreased with time and were similar to those of previous reports: 1.23 episodes of rejections per patients during first 3months after transplantation, 0.25 during second 3months, 0.17 and 0.08 during third and fourth 3 months. Infectious complications developed in 21.4% of patients during the first year after transplantation and infectious agents were Cytomegalovirus (CMV), gram negative bacteria, and Candida. One-year survival rate of recipients was 81.9%. Systemic CMV infection in 1, aortic rupture in 1, and sudden death in 1 patient were the causes of mortality, all of which developed during early post-transplantation period. CONCLUSION: Cardiac transplantation seems to be a reasonable therapeutic regimen for patient with end stage heart failure even in this country with limited experience; however, close attention and management against acute rejection and infectious complications, especially during the early post-transplantation period, are critical for long term survival.
Adult* ; Aortic Rupture ; Candida ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cardiomyopathy, Restrictive ; Cytomegalovirus ; Death, Sudden ; Follow-Up Studies ; Gram-Negative Bacteria ; Heart Failure ; Heart Transplantation* ; Heart Valve Diseases ; Humans ; Korea ; Male ; Mortality ; Seoul ; Survival Rate ; Tachycardia