PURPOSE: The authors report their experience with four cases of paralytic exotropia from a pit viper snakebite, accompanied with a literature review. METHODS: Four patients (two males and two females) visited the emergency room in the hospital with symptoms including diplopia, limitation of eye movement, exotropia, and blepharoptosis, after being bitten by a presumed pit viper, and were treated by antivenom. RESULTS: No visual disturbance was observed in the first examination, while limitation of adduction was found in four cases in the ocular movement test. As to the type of tropia, three patients showed intermittent exotropia and the other showed exotropia. The angle of strabismus in the distance was 20~30 prism diopters (PD) while that in the near was 18~35 PD. Two cases were accompanied with blepharoptosis. Except one case which was unavailable for follow-up observation, three cases became normal in diplopia, blepharoptosis, and limitation of ocular movement between the 4th and 11th day after the snakebite. CONCLUSIONS: Neurotoxicity induced by a pit viper snakebite is rare. However, neurotoxicity including strabismus and blepharoptosis can occur because extraocular muscles have a higher ratio of nerve fibers to the extraocular muscle fibers compared with skeletal muscles.
Blepharoptosis ; Diplopia ; Emergency Service, Hospital ; Exotropia* ; Eye Movements ; Follow-Up Studies ; Humans ; Male ; Muscle, Skeletal ; Muscles ; Nerve Fibers ; Snake Bites* ; Strabismus

No abstract available.
Humans

No abstract available.

Malignant germ cell tumors of the ovary are uncommon neoplasms. Although 20-25% of all ovarian tumors are derived from germ cells, only about 3% of germ cell tumors are malignant. Mixed germ cell tumors contain at least two malignant germ cell elements. These lesions should be managed with combination chemotherapy, preferably BEP. Recently we experienced a case of mixed germ cell tumor with 6 components of germ cell and sarcomatous change in a 11 year old girl. Preoperative CA-125, B-hCG, aFP, LDH, a-1-antitrypsin were elevated and the final pathologic report was mixed germ cell tumor composed of endodermal sinus tumor, embryonal carcinoma, mature and immature teratoma, choriocarcinoma, dysgerminoma and sarcomatous change, Postoperative chemotherapy with 6 courses of BEP regimen was performed and all tumor markers became normal after 4 courses of chemotherapy. What we interested in this case was several components of germ cells and sarcomatous change and the sarcomatous change might be derived from the mature cystic teratoma component, so we present this case with a brief review of the literatures here.
Carcinoma, Embryonal ; Child ; Choriocarcinoma ; Drug Therapy ; Drug Therapy, Combination ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Pregnancy ; Teratoma ; Biomarkers, Tumor

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

No abstract available.

BACKGROUND AND OBJECTIVES: A human cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium from hyperproliferative properties. It needs intercellular signal exchange through gap junctions as well as intracellular signal pathway for hyperproliferation. Connexin (Cx) is a gap junction protein for intercellular communication, and especially Cx26 and Cx43 are plenty in human epithelial cells. The objective of this study was to analyze the expression pattern of Cx43 and Cx26 in human middle ear cholesteatomas against normal epitheliums. SUBJECTS AND METHOD: Ten retroauricular skins (RAS), ear canal skins (ECS), and cholesteatomas were taken during middle ear operations at the Department of Otolaryngology. Immunohistochemical staining, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were used to detect Cx43 and Cx26. RESULTS: In human cholesteatomas, Cx43 were expressed in the whole suprabasal layers, especially in the middle portion, except in the basal layer, and Cx26 were usually expressed in the supra layer and in the basal layers. But normal RASs showed weak expression of Cx43 in the upper spinosal and granular layers, but not in the basal layers, and the restricted localization of Cx26 in the basal layer. The expression of Cx43 and Cx26 in EASs was weak but showed similar patterns to that of cholesteatomas. In RT-PCR and Western blot, the expression of Cx43 and Cx26 were increased in cholesteatomas than in RASs. CONCLUSION: Human middle ear cholesteatomas showed upregulated expression and different localization of Cx43 and Cx26, gap junction proteins for intercellular communication, compared with normal RASs, suggesting that perturbations of intercellular communication through gap junctions may be associated with the pathology of human middle ear cholesteatomas.
Blotting, Western ; Cholesteatoma ; Cholesteatoma, Middle Ear* ; Connexin 43 ; Connexins* ; Ear Canal ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gap Junctions* ; Humans* ; Otolaryngology ; Pathology ; Signal Transduction ; Skin

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory abnormal findings. BMS is not an uncommon disease that ENT doctors can encounter in the OPD clinics. However, the causes, pathophysiology, and treatment of BMS are not known yet, and there are just a few reported articles. The aim of this study was to analyze the characteristics of BMS and to evaluate the effects of steroid gargle treatments. SUBJECTS AND METHOD: We reviewed 18 patients with BMS who visited the Department of Otolaryngology, Ajou University Hospital. The patients were analyzed according to the sites, duration of their burning sensations and associated symptoms. Furthermore, the interview included inquiries regarding current diseases, on-going medications, smoking history and psychological factors. The change of symptoms after steroid gargle treatment with/without other drugs was carefully analyzed. RESULTS: The average age of patients with BMS was 56.4 years old, and the male to female ratio was 8:10. The most frequently involved site was tongue (94.4%), followed by lower lip, gingiva, palate, and floor of mouth. We found that the causes of BMS were psychogenic factors for 4 patients, and diabetes mellitus and hypertension for 2 patients each. Approximately 80.0% (8/10 patients) of the women was menopausal. Six (50.0%) of 12 patients treated only with steroid gargle and 3 (75.5%) of 4 patients treated with steroid gargle and other medications showed relieved symptoms. CONCLUSION: Burning mouth syndrome is not an uncommon disease in the ENT field, and has complex etiology. Although the definitive treatment for BMS is not known yet, we think that steroid gargle may be helpful in the treatment of BMS.
Burning Mouth Syndrome* ; Burns* ; Diabetes Mellitus ; Female ; Gingiva ; Humans ; Hypertension ; Lip ; Male ; Mouth Floor ; Otolaryngology ; Palate ; Psychology ; Sensation ; Smoke ; Smoking ; Steroids ; Tongue

OBJECTIVES: The aim of this prospective study is to investigate predictors estimating relapse in Korean alcohol-dependent patients using variables like alcohol history, drinking craving, treatment motivation and insight. METHODS: Alcohol dependent patients(N=48) who completed questionnaires about sociodemographic variables and drinking history, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCSD), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS) were followed-up for 24weeks. Subjects who drank heavily(5 standard drinking or more/day) or were not followed up anymore were classified as the relapse group. We used logistic regression analysis with backward elimination of SPSS PC+11.5 to investigate relapse estimate predictors. RESULTS: Average drinking amount per drinking day for last 1 year and HAIS score were predictors of relapse in alcohol-dependent patients. CONCLUSIONS: Our findings suggest that therapist should give more attention to alcohol-dependent patients who had more drinks per drinking day for last 1 year and had lower insight level.
Alcoholism ; Drinking ; Follow-Up Studies* ; Humans ; Logistic Models ; Motivation ; Pennsylvania ; Prospective Studies ; Recurrence* ; Rhode Island

Immature teratoma is composed of varying quantities of immature differentiating among anyone or all three germ layer. The pure immature teratoma accounts for fewer than 1% of all ovarian cancer, but it is the second most common germ cell malignancy. About 50% of pure immature teratomas of the ovary occur in women between the ages of 10 and 20 years, and they rarely occur in postmenopausal women. The most frequent site of dissemination is the peritoneum, and much less commonly, the retroperitoneal lymph node. Among the tumors with embryonal elements, those containing neural tissues demonstrate most clearly the importance of the ability to mature. Gliomatosis peritonei is the most dramatic demonstration of the significance of maturation, because most patients with these tumors have survived, even with this disseminated disease. The purpose of this paper is to report on a immature ovarian teratoma with predominantly mature glial tissues in peritoneum which we have experienced in this hospital recently with brief review of the literature.
Female ; Germ Cells ; Germ Layers ; Humans ; Lymph Nodes ; Ovarian Neoplasms ; Ovary* ; Peritoneum ; Teratoma*