OBJECTIVE: To identify possible clinical predictors of intermittent oro-esophageal (OE) tube feeding success, and evaluate the clinical factors associated with OE tube treatment. METHODS: A total of 135 dysphagic patients were reviewed, who received OE tube treatment and were hospitalized in the department of rehabilitation medicine between January 2005 and December 2014. The 76 eligible cases enrolled were divided into two groups, based on the OE tube training success. Clinical factors assessed included age, cause of brain lesion, gag reflex, cognitive function and reasons for OE tube training failure. RESULTS: Of the 76 cases enrolled, 56 study patients were assigned to the success group, with the remaining 20 in the failure group. There were significant differences between these two groups in terms of age, gag reflex, ability to follow commands, and the score of Korean version of Mini-Mental Status Examination (K-MMSE). Location of the brain lesion showed a borderline significance. Multivariable analysis using logistic regression revealed that age, cause of brain lesion, gag reflex, and K-MMSE were the main predictors of OE tube training success. CONCLUSION: A younger age, impaired gag reflex and higher cognitive function (specifically a K-MMSE score ≥19.5) are associated with an increased probability of OE tube training success in dysphagic patients.
Brain Injuries* ; Brain* ; Cognition ; Deglutition Disorders* ; Enteral Nutrition* ; Humans ; Logistic Models ; Multivariate Analysis ; Reflex ; Rehabilitation

Interruption of the aortic arch is an uncommon congenital cardiovascular malformation invariably accompanied by other cardiovascular anomalies. This carries a 76% mortality rate in the first month of life. We recently experienced a case of interruption of the aortic arch with patent ductus arteriosus in a 21-year-old man with systolic murmur. he did not showed any other symptoms or signs. Cardiac catheterization with angiography showed interruption of the aortic arch with many systemic arterial collaterals and patent ductus arteriosus.
Angiography ; Aorta* ; Aorta, Thoracic ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent* ; Humans ; Mortality ; Systolic Murmurs ; Young Adult

BACKGROUND: Sparganosis is a larval cestodiasis caused by the plerocercoid of Spirometra spp. Since the first description of human sparganosis in 1924, several hundred cases have been reported in Korea. However, systematic approaches for literature surveys of Korean sparganosis have seldom appeared. METHODS: We searched publicly available databases such as PubMed, Research Information Sharing Service, and Korea Medical Citation Index with relevant Medical Subject Headings. RESULTS: At least 438 Korean sparganosis cases have been described from 1924 to 2015. Preoperative diagnosis has been significantly increased since the 1980s due to popularization of serological and imaging diagnostics. Cases were largely detected from fifth decades in general, but cerebral sparganosis was detected in relatively young age groups (third and fourth decades). Sparganosis was prevalent in men (75.9%). Consumption of frog/snake and drinking unfiltered water were found in 63.4% and 16.9% of patients, respectively. Most frequently affected sites were subcutaneous tissues (49.9%), followed by the central nervous system (36.2%). Involvements of visceral organs (7.6%), ocular regions (3.6%), and muscles (2.7%) were noticed. In women, breast sparganosis constituted a large proportion (34.2%). Sparganosis associated with immunocompromised patients has recently been reported. CONCLUSION: Sparganosis has been continuously reported in Korea during the past 90 years, although its incidence has decreased during the last 20 years. The disease is mostly characterized by subcutaneous nodule, but infection of the worm in vital organs often results in serious illness. Continuous awareness is warranted to monitor sparganosis occurrence and associated clinical consequences.
Breast ; Central Nervous System ; Diagnosis ; Drinking ; Female ; Humans* ; Immunocompromised Host ; Incidence ; Information Dissemination ; Korea* ; Male ; Medical Subject Headings ; Muscles ; Sparganosis* ; Sparganum ; Spirometra ; Subcutaneous Tissue ; Water

Since Gagner introduced the first endoscopic parathyroidectomy in 1996, various approaches for endoscopic thyroidectomy & parathyroidectomy have been proposed. We have recently developed an unilateral axillo-breast approach for endoscopic thyroid surgery without gas insufflation. Through our experiences of more than 100 cases of endoscopic thyroidectomy, we have recently performed the endoscopic removal of parathyroid tumors. Case 1 was diagnosed as parathyroid adenoma, and we could not exclude the possibility of a thymic cyst, bronchogenic cyst, or brachial cleft cyst before the operation in Case 2. The final pathologic diagnosis of case 2 was a parathyroid cyst. To our knowledge, this is the first report of endoscopic removal of parathyroid tumor by an ENT surgeon in this country. This report suggests that endoscopic removal of parathyroid tumor or paratracheal mass via unilateral axillo-breast approach without gas insufflation could be a valid option for selective patients with major concern of cosmesis.
Bronchogenic Cyst ; Endoscopy ; Humans ; Insufflation ; Mediastinal Cyst ; Parathyroid Neoplasms ; Parathyroidectomy ; Thyroid Gland ; Thyroidectomy

Objective: Early identification of dysphagia after stroke helps in preventing aspiration pneumonia. However, data are limited regarding the effectiveness of formal dysphagia screening for reducing the risk of aspiration pneumonia.The current study evaluates the effectiveness of formal dysphagia screening in stroke patients, to prevent future episodes of aspiration pneumonia. Methods: The stroke registry of a tertiary hospital was retrospectively reviewed. We compared clinical variables and the incidence of aspiration pneumonia of patients hospitalized between 2014 and 2015 after formal screening was implemented, and patients hospitalized in 2011 when no established dysphagia screening protocol was in place.Additionally, we identified the incidence of pneumonia according to stroke severity, and evaluated the association with results obtained for incidence of pneumonia and dysphagia screening. Results: A total of 2,902 patients were identified to have suffered acute stroke (2,018 who underwent formal dysphagia screening; 884 without screening). Patients with formal dysphagia screening developed pneumonia less frequently than patients not administered screening (1.3% with formal screening vs. 3.4% no formal screening, P＜0.001).Pneumonia was significantly lower in patients with moderate and severe stroke who underwent formal dysphagia screening. Furthermore, failure of the dysphagia screening test, presentation with severe dysarthria, and conditions where dysarthria could not be evaluated, were independent predictors of pneumonia among patients who underwent formal screening. Conclusion Our findings demonstrate the association of formal dysphagia screening with reduced risk of poststroke aspiration pneumonia, and indicates the efficacy of the procedure in identifying patients at higher risk of contracting pneumonia.

OBJECTIVE: UFT plus leucovorin treatment had favorable activity and tolerable toxicity in patients with advanced stomach cancer. Recently, high response rates have been reported in patients with advanced stomach cancer with a schedule of epirubicin, cisplatin, and protracted infusion of 5-fluorouracil (5-FU). The advantage of long term oral administration of UFT is that this treatment might be used to mimic protracted infusions of 5-FU. Instead of inconvenience of infusion pump and intravenous catheter for protracted infusion of 5-FU, we administered UFT plus leucovorin in this treatment. METHODS: Thirty-seven patients with locally advanced or metastatic stomach cancer received epirubicin, cisplatin, oral UFT plus leucovorin. Epirubicin 50 mg/m2 and cisplatin 60 mg/m2 were administered on day 1 by intravenous injection. UFT 360 mg/m2/day in conjunction with leucovorin administered at 25 mg/m2/day per os in divided daily doses for 21 days followed by a 7-day rest period. Courses were repeated every 4 weeks. The median age of the patients was 55 years with a median World Health Organization (WHO) performance status of 1. Patients received a median of four courses of treatment (range, 2 to 10). RESULTS: Among 37 evaluable patients, two patients achieved complete response, and eighteen had partial responses, for an overall response rate of 54% (95% confidence interval; 39% to 70%). Stable disease was reported in 12 patients (32.5%) and another 5 (13.5%) showed disease progression. The median duration of survival was 10 months (range, 2 to 15+). The main toxicity was nausea/vomiting, leukopenia, diarrhea and oral mucositis. Significant toxicity (WHO grade 3 or 4) included leukopenia in fourteen patients (39.8%), nausea/ vomiting in eleven (29.7%), oral mucositis in five (13.5%), and diarrhea in four (10.8%) patients. CONCLUSION: We conclude that epirubicin, cisplatin, oral UFT plus leucovorin, a convenient out-patient regimen, has a significant activity in patients with stomach cancer and has tolerable toxicities.
Administration, Oral ; Appointments and Schedules ; Catheters ; Cisplatin* ; Diarrhea ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Epirubicin* ; Fluorouracil ; Humans ; Infusion Pumps ; Injections, Intravenous ; Leucovorin* ; Leukopenia ; Outpatients ; Stomach Neoplasms* ; Stomach* ; Stomatitis ; Vomiting ; World Health Organization

BACKGROUND AND OBJECTIVES: Tetranychus urticae(TU) is a widely distributed parasitic mite found on fruit trees and green house flowers. A recent investigation demonstrated that TU inhalation causes allergic asthma even in non-farmers. We tried to evaluate skin reactivity and specific IgE sensitization to TU, identify IgE binding components, and evaluate allergenic rela- tionship with house dust mite(HDM). MATERIALS AND METHODS: We carried out skin prick test with TU in 1806 respiratory allergy patients over 1 year living in urban and rural areas. ELISA was performed for detection of specific IgE antibody. To evaluate the cross allergenicity between TU and HDM, ELISA inhibition test was carried out with two kinds of pooled sera ; serum pool A included patients' sera sensitized to both TU and HDM, and serum pool B included sera sensitized only to TU. To identify IgE binding components, SDS-PAGE followed by IgE-immunoblot were applied. RESULTS: 358 patients(19.8%) showed positive response(A/H > or = 2+) on skin prick test. Twelve patients showed isolated positive response to TU. Specific IgE was detected in sixty patients(54.5%) out of 110 sensitized patients. ELISA inhibition test using two sera pools (A and B) showed significant inhibitions by TU with minimal inhibitions by HDM. SDS-PAGE and IgE-immunoblot with patients' individual sera sensitized to both TU and HDM showed 10 IgE binding components (67kD, 29kD, 27kD, 10kD, 14kD, 39kD, 46kD, 35kD, 72kD, 77kD) and two(67kD and 29kD) were bound to IgE in more than 50% of sera tested. In patients' sera sensitized only to TU, nine IgE binding components(67kD, 10kD, 14kD, 29kD, 39kD, 46kD, 72kD, 77kD, 9kD) were found and two(67kD and 10kD) were bound to IgE in more than 50%. CONCLUSION: Of allergy patients visiting the Allergy Clinic, 19.8% were sensitized to TU and specific IgE was detected in 54.5% of them. No cross allergenicity was noted between TU and HDM. Eleven IgE binding components and three (67kD, 10kD and 29kD) major allergens were identified.
Allergens ; Asthma ; Dust ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Flowers ; Fruit ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Inhalation ; Mites ; Pyroglyphidae ; Skin* ; Trees

BACKGROUND AND OBJECTIVE: The Allergodip(R) multi-allergen screening test is a simple method for measuring serum-specific IgE to common inhalant allergens simultaneously. The dipstick contains nine separate allergen pads including D. pteronyssinus, Alternaria, cat epithelium, dog epithelium, English plantain, mugwort, birch, rye and six-grass mixture pollen extracts, as well as positive and negative controls. This study was performed in order to evaluate sensitivity and specificity of this test in comparison to skin prick test. MATERIALS AND METHOD: We compared the results obtained by skin prick test (PT) to those obtained by Allergodip(R) test (AT) in 30 patients with various allergic diseases. The skin reactivity was presented as allergen to histamine ratio (A/H) and results of the AT test were assessed visually and classified into Allergodip(R) class 0-4. RESULTS: Compared with PT, results of AT gave a sensitivity of 55.3% and a specificity of 93.8% when the A/H > OR = 3 was considered a positive response for PT. The agreement rate between positive PT and positive AT to each antigen was 82.6% in D. pteronyssinus, 82.9% in Alternaria, 71.1% in dog epithelium, 57.2% in mugwort pollen, 57.2% in birch pollen, 49.9% in grasses mixture pollen, 23.6% in cat epithelium and 6.7% in rye grass pollen, respectively. Significant correlations were noted between PT and AT classes in D. pteronyssinus, Alternaria, dog epithelium, mugwort pollen, birch pollen, and in grasses mixture pollen (p < 0.05, respectively), but not in cat epithelium or rye grass pollen. CONCLUSION: We concluded that Allergodip(R) test is useful in screening serum-specific IgE antibodies against multiple allergens at one time.
Allergens ; Alternaria ; Animals ; Antibodies ; Artemisia ; Betula ; Cats ; Dogs ; Epithelium ; Histamine ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Lolium ; Mass Screening* ; Plantago ; Poaceae ; Pollen ; Secale ; Sensitivity and Specificity ; Skin

Human chorionic gonadotropin (HCG) is one of the glycoproteins families synthesized by the placenta, and consists of 2 noncovalently joined subunits, namely, alpha and beta. The alpha and beta-subunits have a structural homology with the alpha and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG, accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic diseases (GTD), such as a hydatidiform mole or a choriocarcinoma. However, the clinical symptoms of hyperthyroidism in GTD are rarely observed. A 27-years-old woman, admitted due to an amenorrhea of 11 weeks duration, with thyrotoxic symptoms, such as weight loss, palpitation, sweating, tremor, heat intolerance and anxiety, was evaluated. Her serum free T4 level was 8 times higher than normal, and her serum beta-HCG level was over 1,000,000IU/L. She had a curettage operation, with the pathological findings of a complete hydatidiform mole. These thyrotoxic symptoms developed due to a hydatidiform mole, and were accompanied with a highly increased serum beta-HCG level. After evacuation of the molar tissue, the thyroid hormone and thyrotoxic symptoms normalized. Here, this case is reported, with brief review of the literature.
Amenorrhea ; Anxiety ; Choriocarcinoma ; Chorionic Gonadotropin ; Curettage ; Female ; Gestational Trophoblastic Disease ; Glycoproteins ; Hot Temperature ; Humans ; Hydatidiform Mole* ; Hyperthyroidism ; Molar ; Placenta ; Pregnancy ; Receptors, Thyrotropin ; Sweat ; Sweating ; Thyroid Gland ; Thyrotoxicosis* ; Tremor ; Weight Loss

OBJECTIVE: The absence of collateral ventilation (CV) is crucial for effective bronchoscopic lung volume reduction (BLVR) with an endobronchial valve. Here, we assessed whether CT can predict the Chartis™ results. MATERIALS AND METHODS: This study included 69 patients (mean age: 70.9 ± 6.6 years; 66 [95.7%] males) who had undergone CT to assess BLVR eligibility. The Chartis™ system (Pulmonox Inc.) was used to check CV. Experienced thoracic radiologists independently determined the completeness of fissures on volumetric CT images. RESULTS: The comparison between the visual and quantitative analyses revealed that 5% defect criterion showed good agreement. The Chartis™ assessment was performed for 129 lobes; 11 (19.6%) of 56 lobes with complete fissures on CT showed positive CV, while this rate was significantly higher (40 of 49 lobes, i.e., 81.6%) for lobes with incomplete fissures. The size of the fissure defect did not affect the rate of CV. Of the patients who underwent BLVR, 22 of 24 patients (91.7%) with complete fissures and three of four patients with incomplete fissures (75%) achieved target lobe volume reduction (TLVR). CONCLUSION: The quantitative analysis of fissure shows that incomplete fissures increased the probability of CV on Chartis™, while the defect size did not affect the overall rates. TLVR could be achieved even in some patients with relatively large fissure defect, if they showed negative CV on Chartis™.
Cone-Beam Computed Tomography ; Emphysema ; Humans ; Lung ; Pneumonectomy ; Pulmonary Disease, Chronic Obstructive ; Ventilation