The incidence of mastoiditis in pediatric age has consistently increased over the last two decades due to increase of antibiotic-resistant bacteria. Compared to young patients, occurrence of acute otitis media complications such as acute mastoiditis and subperiosteal abscess is relatively low in adults. Various treatments for acute mastoiditis with subperiosteal abscess such as tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage have avoided the morbidity and necessity of mastoid surgery. Recently, many studies have indicated mastoidectomy only in cases of severe complications or failure of disease improvement after antibiotic treatment and myringotomy. In this report, we present two cases of successful treatment of subperiosteal abscess and discuss the management of acute mastoiditis with subperiosteal abscess in both child and adult.
Abscess ; Adult ; Anti-Bacterial Agents ; Bacteria ; Child ; Drainage ; Humans ; Incidence ; Mastoid ; Mastoiditis ; Middle Ear Ventilation ; Otitis Media

Objectives: . The aim of this study was to evaluate vestibular function loss after cochlear implantation (CI) and the relationship between vestibular function and hearing changes. Methods: . Seventy-five patients with CI were enrolled and divided into those with normal preoperative caloric function (group I) and those with a normal preoperative waveform in cervical vestibular evoked myogenic potential (c-VEMP) testing (group II). The relationship between hearing and changes in the vestibular system was analyzed preoperatively and at 3 and 6 months postoperatively. Results: . In group I, unilateral weakness on the implanted side was detected in five (7.7%) and eight (12.3%) patients at 3 and 6 months post-CI, respectively. By 3 months post-CI, the total slow-phase velocity (SPV; warm and cold stimulations) was significantly different between the implanted and non-implanted sides (P=0.011), and the shift in total SPV from pre- to post-CI was significantly correlated with the average hearing threshold at 6 months post-CI. In group II, an abnormal c-VEMP was detected on the implanted side in six patients (16.2%) at 3 months post-CI, and in six patients (16.2%) at 6 months post-CI. Significant changes were noticed in the P1 and N1 amplitude at 3 months postCI (P=0.027 and P=0.019, respectively). Conclusion . Vestibular function and residual hearing function should be afforded equal and simultaneous consideration in terms of preservation.

Type II mucopolysaccharidosis (MPS II) commonly known as Hunter syndrome, is a rare X-linked lysosomal storage disorder caused by iduronate-2-sulfatase deficiency, which in turn causes otorhinolaryngological manifestations, including sensorineural hearing loss (SNHL). Previously, the median survival age of patients with MPS was approximately 13.4 years. However, in the era of enzyme replacement therapy and other multidisciplinary care modalities, the life expectancy has increased. Herein, we report a rare case of an adolescent with MPS II who underwent SNHL treatment with cochlear implantation (CI). Based on unexpected findings of mastoid emissary veins and overgrowth of the vessels around the temporal bone, CI was performed using the transmeatal approach instead of the conventional transmastoid method, to avoid damage to the vessels. The average hearing threshold after CI was 35 dB and no surgical complications were encountered. Adolescent MPS II may present vessel abnormalities, which can reduce the success rate of surgery. In patients with MPS II with SNHL, CI should be performed under careful monitoring of vessel overgrowth. Moreover, with regard to feasibility of CI in adolescent patients with MPS II with SNHL, surgical techniques such as the transmeatal approach should be selected based on adequate assessment of the case.

PURPOSE: The aim of this study was to compare the film thicknesses of several resin cements as a function of time after mixing and to examine the effect of working time on the film thicknesses. MATERIALS AND METHODS: The film thickness (microm) of 4 resin cements (n=10), 1 composite resin (Panavia F 2.0), 3 self-adhesive resin (Clearfil SA luting, Zirconite, RelyX U200) cements was measured at 20-second intervals after mixing of the cements up to 200 seconds under a load of 50 N. Linear regression was fitted to verify the effect of working time on the film thickness of each cement. Data were compared to the working time recommended by manufacturers using Wilcoxon test (alpha=.05). RESULTS: All of the materials showed a positive linear correlation between the film thickness and working time. There was no statistically significant difference between the working time based on our results and the values recommended by the manufacturers even though there was a discrepancy between those two values. CONCLUSION: The film thickness of resin cements could increase with the increase of working time. Working time to meet the ISO standard of 50-microm maximum film thickness could be different from the manufacturer's recommended value.
Linear Models ; Resin Cements ; Resins, Synthetic*

Spontaneous herniation of the spinal cord is a very rare. It's clinical symptom presents with progressive myelopathy. A 42-year old male patient who presented the progressive left leg weakness and Brown-Seqaurd syndrome is presented. MRI showed a typical finding of dural defect and herniation of the cord on the level of T3-4. Repair of dural defect using an artificial dura and reposition of cord herniation were undertaken after three level laminectomies with SSEP monitoring. Postoperatively, symptoms were improved rapidly. In our knowledgement,this is first case being reported in Korea. This entity, although rare, should be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.
Adult ; Brown-Sequard Syndrome ; Diagnosis, Differential ; Humans ; Korea ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Male ; Spinal Cord Diseases ; Spinal Cord*

PURPOSE: To demonstrate the effectiveness of the conservative treatment which was introduced to the extraarticular triplane fractures of the distal tibia. MATERIALS AND METHODS: We reviewed radiographs and medical records of eight patients with extraarticular triplane fractures of the tibia. Four patients were treated with closed reduction and internal fixation and the others with closed reduction and plaster. RESULTS: In all patients, the union of fractures was obtained. Although the physes were closed early, there was no angular deformity or leg length discrepancy. CONCLUSION: In case of extraarticular triplane fracture, except for open fracture or failure of closed reduction, conservative treatment yield good result.
Child* ; Congenital Abnormalities ; Fractures, Open ; Humans ; Leg ; Medical Records ; Tibia*

PURPOSE: The purpose of this study was to evaluate the accuracy of each method of counting ribs on chest CT and to propose a new method: the anterior approach with using the sternocostal joints. MATERIALS AND METHODS: CT scans of 38 rib lesions of 27 patients were analyzed (fracture: 25, metastasis: 11, benign bone disease: 2). Each lesion was independently counted by three radiologists with using three different methods for counting ribs: the sternoclavicular approach, the xiphisternal approach and the modified sternomanubrial approach. The rib lesions were divided into three parts for evaluation of each method according to the location of the lesion as follows: the upper part (between the first and fourth thoracic vertebra), the middle part (between the fifth and eighth) and the lower part (between the ninth and twelfth). RESULTS: The most accurate method was a modified sternomanubrial approach (99.1%). The accuracies of a xiphisternal approach and a sternoclavicular approach were 95.6% and 88.6%, respectively. A modified sternomanubrial approach showed the highest accuracies in all three parts (100%, 100% and 97.9%, respectively). CONCLUSION: We propose a new method for counting ribs, the modified sternomanubrial approach, which was more accurate than the known methods in any parts of the bony thorax, and it may be an easier and quicker method than the others in clinical practice.
Bone Diseases ; Humans ; Neoplasm Metastasis ; Ribs* ; Sternocostal Joints ; Thorax* ; Tomography, X-Ray Computed*

OBJECTIVES: Parkinson's disease is one of the most common neurodegenerative diseases in the elderly population. In order to estimate the prevalence of Parkinson's disease in the community, the application of a good screening tool is essential. We evaluated the validity and reliability of a Parkinson's disease screening questionnaire and propose an alternative measure to improve its validity for use in community surveys. METHODS: We designed the study in a three-phase approach consisting of a screening questionnaire, neurologic examination, and confirmatory examination. A repeated survey was administered to patients with disease detected in the community and on 150 subjects. We examined internal consistency using Cronbach's alpha test, test-retest reliability using the kappa statistic, and validity using sensitivity, specificity, and ROC curves. Unadjusted odds ratios were utilized for the estimation of weights for each questionnaire item. RESULTS: The Cronbach's alpha of the questionnaire was 0.708. The kappa statistic for test-retest reliability was good to generally fair in most of the items. When newly proposed weighting scores were used, the optimum cut-off value was 7/8. When cut-off value was 5/6 for surveying prevalence in a community, the sensitivity was 0.98, and the specificity was 0.61, with simultaneous improvement in reliability. CONCLUSIONS: We recommend 5/6 as the ideal cut-off value for the survey of PD prevalence in community. This questionnaire designed for the Korean community could help future epidemiologic studies of PD.

This study was aimed to evaluate the ability of imaging parameters measured on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI) and positron emission tomography/computed tomography (PET/CT) to serve as response markers in breast cancer after neoadjuvant chemotherapy (NAC). In 20 patients with breast cancer, DCE-MRI and DWI using a 3 T scanner and PET/CT were performed before and after NAC. DCE-MRI was analyzed using an automatic computer-aided detection program (MR-CAD). The response imaging parameters were compared with the pathologic response. The areas under the curve (AUCs) for DCE-MRI using MR-CAD analysis, DWI and PET/CT were 0.77, 0.59 and 0.76, respectively. The combination of all parameters measured by MR-CAD showed the highest diagnostic performance and accuracy (AUC = 0.77, accuracy = 90%). The combined use of the parameters of PET/CT with DCE-MRI or DWI showed a trend toward improved specificity and negative predictive value (100%, 100%, accuracy = 87.5%). The use of DCE-MRI using MR-CAD parameters indicated better diagnostic performance in predicting the final pathological response compared with DWI and PET/CT, although no statistically significant difference was observed. The combined use of PET/CT with DCE-MRI or DWI may improve the specificity for predicting a pathological response.
Adult ; Aged ; Antineoplastic Agents/*therapeutic use ; Breast Neoplasms/*diagnosis/*drug therapy ; Chemotherapy, Adjuvant/methods ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Magnetic Resonance Imaging/*methods ; Mammography/methods ; Middle Aged ; Multimodal Imaging/methods ; Neoadjuvant Therapy/methods ; Positron-Emission Tomography/*methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Treatment Outcome

An alpha-glucosidase inhibitor was developed from Aspergillus oryzae N159-1, which was screened from traditional fermented Korean foods. The intracellular concentration of the inhibitor reached its highest level when the fungus was cultured in tryptic soy broth medium at 27degrees C for five days. The inhibitor was purified using a series of purification steps involving ultrafiltration, Sephadex G-25 gel permeation chromatography, strong cation exchange solid phase extraction, reverse-phase high performance liquid chromatography, and size exclusion chromatography. The final yield of the purification was 1.9%. Results of the liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis indicated that the purified alpha-glucosidase inhibitor was a tri-peptide, Pro-Phe-Pro, with the molecular weight of 360.1 Da. The IC50 value of the peptide against alpha-glucosidase activity was 3.1 mg/mL. Using Lineweaver-Burk plot analysis, the inhibition pattern indicated that the inhibitor acts as a mixed type inhibitor.
alpha-Glucosidases* ; Aspergillus oryzae* ; Aspergillus* ; Caseins ; Chromatography, Gel ; Chromatography, Liquid ; Dextrans ; Fungi ; Inhibitory Concentration 50 ; Mass Spectrometry ; Molecular Weight ; Protein Hydrolysates ; Solid Phase Extraction ; Ultrafiltration