BACKGROUND AND OBJECTIVES: Recurrent vestibulopathy is defined a disease characterized by more than a single episode of vertigo of duration characteristic of endolymphatic hydrops but without auditory or clinical neurological symptoms or signs. To investigate the clinical characteristics and the efficacy of combination therapy, we analyzed the clinical records of the patients diagnosed as recurrent vestibulopathy. MATERIALS AND METHOD: Clinical records of sixty four patients diagnosed as recurrent vestibulopathy were retrospectively reviewed. The data on age, sex distribution, natural history, family history of recurrent vestibulopathy, concurrent headache, caloric response was analyzed. The efficacy of combination therapy for vertigo control in the patients with a minimum 24-month follow-up was also evaluated. RESULTS: Mean onset age of recurrent vestibulopathy was 43 years and there was a female preponderance. Concurrent headache and elevated SP/AP ratio in electrocochleogram was frequently observed in these patients. After the combination medical therapy, patients with severe recurrent vestibulopathy showed significant decrease in the number of vertigo spells with 37.5% of complete control of vertigo. CONCLUSION: As a distinctive clinical disorder with unknown cause, recurrent vestibulopathy should be always considered to the patients complaining recurrent episodic vertigo. Combination therapy individualized to the symptoms and signs of the patients with recurrent vestibulopathy might be effective in reducing the frequency of vertigo attacks. Further case-control studies with large population should be necessary.
Age of Onset ; Case-Control Studies ; Endolymphatic Hydrops ; Female ; Follow-Up Studies ; Headache ; Humans ; Natural History ; Retrospective Studies ; Sex Distribution ; Vertigo ; Vestibular Neuronitis*

Premature infants with respiratory distress syndrome may have clinically significant shunting through a patent ductus arteriosus (PDA). Left-to-right shunting through the PDA may lead to left ventricular volume overload and pulmonary edema. We present a case of perioperative management for severe respiratory distress syndrome in a premature infant who underwent surgical closure of PDA. Under general anesthesia, the infant was successfully managed by inhaled nitric oxide, high frequency oscillation ventilation with intermittent mandatory ventilation despite intermittent hypoxia. The operation was performed safely in the neonatal intensive care unit.
Anesthesia, General ; Anoxia ; Ductus Arteriosus, Patent* ; High-Frequency Ventilation ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Nitric Oxide ; Pulmonary Edema ; Ventilation

BACKGROUND AND OBJECTIVES: Paper patching for the treatment of traumatic tympanic membrane perforation is a safe, simple, and inexpensive method. This study was designed to evaluate the therapeutic effect of proper paper-patch techniques for traumatic tympanic membrane perforation using more objective measurement of perforated area by image analyzer. SUBJECTS AND METHOD: A prospective study of paper-patch techniques was carried out on 55 patients with traumatic perforations of the tympanic membrane. Objective semiquantitative measurement of the perforated area was performed using computerized image analyzer. Immediate eversion of inverted flaps and single to multiple patching techniques were used in all cases. Treatment results were analyzed according to various variables which may affect the healing rate. RESULTS: The closure rate of tympanic membrane with this paper patching method was 98.2% and the mean healing time was 2.9+/-1.9 weeks. Hearing impairment was correlated with the size of perforation which was measured quantitatively by image analyzer and the healing rate was decreased with infectious signs such as otorrhea. There were no side effects or complications. CONCLUSION: Multiple paper patching with proper technique for traumatic tympanic membrane perforation produced an excellent success rate and could be considered as part of initial therapeutic methods for all cases of large perforation with inverted flap.
Hearing Loss ; Humans ; Prospective Studies ; Tympanic Membrane ; Tympanic Membrane Perforation

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of Tc-99m labeled antigranulocyte antibody immunoscintigrapy in the diagnosis of osteomyelitis and compare with the results of triphasic bone scan. MATERIALS AND METHODS: The study population was 39 patients (22 male, 17 female) who had uncertain diagnoses of osteomyelitis. Fifteen patients had history of orthopedic surgery, and 5 had previous fracture. One milligram of monoclonal antibody against NCA-95 was labeled with 370 MBq of Tc-99m, injected intravenously, and 4 hour images were obtained. Triphasic bone scan images were obtained in 30 p;tients. The final diagnosis was confirmed by bacteriologic culture, biopsy or long term clinical follow up. RESULTS: Twenty one patients were confirmed to have osteomyelitis (1 acute, 20 chronic). Eighteen patients were without osteomyelitis. Antigranulocyte antibody immunoscintigraphy had a sensitivity of 71% (15/21), and a specificity of 89% (16/18), while the sensitivity and specificity of triphasic bone scan was 93% (13/14) and 38% (6/16), respectively. Antigranulocyte antibody scan showed higher specificity of 100% (11/11) in comparison with 33% (3/9) of triphasic bone scan in patients with history of orthopedic surgery or fracture. CONCLUSION: Antigranulocyte antibody immunoscintigraphy is more specific than that of triphasic bone scan and may be helpful in patients with history of surgery or fracture. However, sensitivity is lower than triphasic bone scan in the detection of chronic osteomyelitis.
Biopsy ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Osteomyelitis ; Sensitivity and Specificity

Semicircular canal dehiscence is a rare but well-described condition to be induced noise or straining. Patients with Superior semicircular canal dehiscence (SSCD) present with a wide variety of symptoms. Reported case is a 51-year-old woman who presented with intermittent vertigo and left-side aural fullness for one month after traffic accident. To establish the diagnosis, high resolution temporal bone CT scanning has been performed to demonstrate bone defect overlying superior semicircular canal, and vestibular auditory symptoms and signs are evaluated through vestibular function test and auditory examination. Cognitive behavior therapy, vestibular rehabilitation and vestibular suppressants are prescribed. Auditory symptoms and vertigo have been subsided. At the same time, Presented depression and anxiety have been improved after 3 month treatment and the quality of life of patient has been improved.
Accidents, Traffic ; Anxiety ; Cognitive Therapy ; Depression ; Female ; Humans ; Middle Aged ; Noise ; Quality of Life ; Semicircular Canals ; Sprains and Strains ; Temporal Bone ; Vertigo ; Vestibular Function Tests

No abstract available.

PURPOSE: Peritoneal seeding of gastric cancer is known to have a poor prognosis. With the diagnosis of peritoneal seeding, there is no effective treatment modality. Gastrectomy with chemotherapy or primary chemotherapy is basically one of major options for this condition. This study was conducted to compare the clinical outcomes of these treatments and to identify the better way to improve the prognosis of patients with peritoneal seeding. MATERIALS AND METHODS: Between 2001 and 2007, gastric cancer patients with peritoneal seeding by preoperative or intraoperative diagnosis were reviewed retrospectively. The enrolled patients were divided as primary gastrectomy and primary chemotherapy group. Clinicopathologic characteristics and clinical outcomes of groups were analyzed and compared. RESULTS: Fifty-four patients were enrolled. 21 patients belonged to the group of primary gastrectomy and 33 patients were to the primary chemotherapy group. Among 33 patients of the primary chemotherapy group, 17 patients were received only chemotherapy and 16 patients were received gastrectomy due to the good responses of primary chemotherapy. The 3 years survival rates were 14% in primary gastrectomy group, 55% in patients who received gastrectomy after primary chemotherapy, and 0% in patients with primary chemotherapy only. CONCLUSIONS: Although this study had many limitations, some valuable information was produced. In terms of survival benefits for the gastric cancer patients with peritoneal seeding, primary gastrectomy and additional gastrectomy after primary chemotherapy revealed the better clinical outcomes. But, prospective randomized clinical study and multi-center study are should be performed to decide proper treatment for gastric cancer patients with peritoneal seeding.
Gastrectomy ; Humans ; Prognosis ; Retrospective Studies ; Seeds ; Stomach Neoplasms ; Survival Rate

PURPOSE: In patients with acute neurological symptoms, brain computed tomography (CT) is usually used to exclude hemorrhagic stroke. After CT imaging, there is no rapid, effective biologic marker for differentiating between acute cerebral ischemia and other etiologies, precluding rapid triage for further evaluation. We evaluated the diagnostic value of a panel of biochemical markers. METHODS: We performed the Triage Stroke Panel (Biosite Inc., UK) test using blood samples of patients who were admitted to the emergency department with suspected acute stroke between December, 2007, and March, 2008. The TSP is represented as MMX (multimarker index) compiles from individual biomarker values, based on quantitative measurement of B-type natriuretic peptide (BNP), fibrin degradation products containing D-dimer, matrix metalloproteinase-9 (MMP-9), and S100. All patients were prospectively evaluated with imaging and laboratory tests for final diagnosis. RESULTS: Of 105 patients, 51.4% had ischemic stroke and 48.6% had non-ischemic, non-organic abnormalities, primarily peripheral vertigo. High levels of BNP and MMX were observed in patients with ischemic stroke (both p <0.001). Independent predictors (odds ratio with CIs are given) of ischemic stroke were: female (OR=0.1 [0.2-0.8]), hypertension (OR=5.0 [1.2-21.3]), BNP (BNP >54.7 pg/mL, OR=99.4 [8.5-1,171.0]). A model combining BNP and MMX had 92% specificity and a 91% positive predictive ratio for prediction of acute ischemic stroke. CONCLUSION: Using biomarkers may improve the differential diagnosis of ischemic stroke after initial brain CT imaging for hemorrhagic stroke, rapidly guiding further evaluation and treatment initiation in the emergency department.
Biomarkers ; Brain ; Brain Ischemia ; Diagnosis, Differential ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Hypertension ; Matrix Metalloproteinase 9 ; Natriuretic Peptide, Brain ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Triage ; Vertigo

Palatal myoclonus is a rare condition in which there are rhythmic jerky movements of the soft palate and sometimes of the other muscles innervated by the brainstem A particularly annoying symptom is a rhythmic clicking sound in the ear due to the opening and closing of the Eustachian tube. Orofacial buccal dystonia is a focal dystonia with sustained spasms of the masticatory, facial or lingual muscles. The frequent symptoms of this disease have mainly been reported to be involuntary and possibly painful jaw opening, closing, deflecting and retruding, or a combination of the above. However, the subtle and unnoticeable involuntary movement of multiple facial muscles, which might be an infrequent symptom of orofacial buccal dystonia, makes this disease hard to diagnose. Understanding the functional orofacial anatomy that is responsible for the clinical signs and symptoms is necessary for making a proper diagnosis. Here we report on a rare case of palatal myoclonus that was associated with orofacial buccal dystonia, and such a case has not been previously reported. We describe the diagnostic approach and excellent treatment results after Botulinum toxin A (Dysport) injection and proper counseling.
Botulinum Toxins ; Brain Stem ; Counseling ; Dyskinesias ; Dystonia ; Dystonic Disorders ; Ear ; Eustachian Tube ; Facial Muscles ; Jaw ; Muscles ; Myoclonus ; Palate, Soft ; Spasm ; Tinnitus

Objective tinnitus due to high jugular bulb is a rare presenting symptom. Annoying pulsatile tinnitus caused by high jugular bulb which may cause sleep disturbance or hearing impairment can be treated by surgical therapy of ligation of internal jugular vein. We present a case of pulsatile tinnitus with high jugular bulb which has been treated by surgical therapy. Otologic examination demonstrated bluish mass in hypotympanic portion behind intact tympanic membrane and temporal bone CT showed the high jugular bulb. Audiological characteristics and the nature of tinnitus was also described. After the angiographic examination, the site for venous ligation was confirmed by compression of internal jugular vein with the probe of doppler sonogram. The patient's pulsatile tinnitus has completely disappeared two weeks after surgery.
Hearing Loss ; Jugular Veins* ; Ligation* ; Temporal Bone ; Tinnitus* ; Tympanic Membrane