Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.
Choristoma ; Electrocoagulation ; Female ; Foreign Bodies ; Gastric Mucosa ; Humans ; Oropharynx ; Pharynx ; Sensation

BACKGROUND: The balance between self- and social identity on job value of Korean dance artists, considered as performing artists, was measured to investigate the relationship between balance and depressive symptoms. METHODS: Data of 139 dance artists were analyzed for depressive symptoms assessed by their responses to questionnaires from the Center for Epidemiologic Studies Depression (CESD) translated into Korean. The balance score of each aspect of social identity compared to that of self-identity on job value was measured and classified as lower, equal, or higher. Following a graphical approach, we performed locally weighted scatterplot smoothing algorithm, simple linear regression, and quadric equation regression. RESULTS: The mean of CESD was highest in the higher balance group and lowest in the lower balance group. There was a linear relationship between balance score and CESD regarding specific audience, unspecified audience, and unspecified public. Balance score showed no association with other aspects of social identity. In the balance score range of 1 or higher, it was associated with CESD with respect to artist colleague, unspecified audience, and unspecified public. CONCLUSIONS: Dance artists should maintain a balance between self- and social identity in job value to prevent depressive symptoms.
Dancing ; Depression ; Epidemiologic Studies ; Korea ; Linear Models ; Social Identification

BACKGROUND AND OBJECTIVES: We evaluated the role of temporary injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP) after cardiothoracic surgeries. SUBJECTS AND METHOD: Taking the introduction of injection laryngoplasty as a milestone, we divided patients into those who underwent cardiothoracic surgery with UVFP during the years 2001-2004, before the introduction of injection laryngoplasty as pre-injection group (n=83) and those who underwent after the introduction during the years 2000-2007 as post-injection group (n=103). Of the post injection group, patients who received injection laryngoplasty postoperatively before being discharged were defined as injection group (n=37). Patients were also divided into non-esophageal surgery group and esophageal surgery group. Clinical outcomes including the length of hospital stay and oral feeding initiation time were compared between the pre-injection group and the injection group within the same operation group. The degrees of aspiration were classified into 4 grades. RESULTS: In the non-esophageal surgery group, the injection group with aspiration grade III had shorter hospital stay and oral feeding initiation time after extubation compared to the pre-injection group with grade III aspiration (p=0.042). However, in the esophageal surgery group, there was no statistical difference between the pre-injection and injection groups. CONCLUSION: Temporary injection laryngoplasty can reduce the hospital stay and enhance oral feeding initiation in patients with aspiration due to UVFP after non-esophageal cardiothoracic surgeries.
Humans ; Laryngoplasty ; Length of Stay ; Paralysis ; Respiratory Aspiration ; Thoracic Surgery ; Vocal Cords

BACKGROUND AND OBJECTIVES: Mitomycin-C is becoming one of the most important agents in the treatment of glottic and subglottic stenosis. This study was conducted to investigate the clinical outcome of endoscopic management in glottic and subglottic stenosis patients using cold instruments and Mitomycin-C. SUBJECTS AND METHODS: A total of 47 patients with glottic and subglottic stenosis who were diagnosed and surgically treated in Seoul National University Children's Hospital from Jan. 2000 through Aug. 2003 were included. All were treated for endoscopic laryngomicrosurgery using cold instruments and bougienage. Thereafter, 0.4 mg/ml Mitomycin-C was directly applied for 5minutes on the surgical site. The surgical treatment outcome was retrospectively analyzed by reviewing medical records. RESULTS: All the studied patients showed improved airway stenosis and subjective symptoms, and twenty-one out of 47 patients have been decannulated successfully without any special complications. Mean number of operation for decannulation was 5.1, and the mean duration from the initial operation to decannulation was 17.3 months. CONCLUSION: Our data suggest that the use of cold instrumentation and topical mitomycin-C application might be a promising, initial choice of management in patients with airway stenosis.
Constriction, Pathologic* ; Humans ; Laryngostenosis ; Medical Records ; Mitomycin* ; Retrospective Studies ; Seoul ; Treatment Outcome

Pyogenic granulomas (PGs) are rare benign lobular capillary hemangiomas that occur on the skin or mucosa. The most common sites of PG occurrence are the skin, lip, face and finger. This entity is extremely rare in the alimentary tract, with the exception of the oral cavity. We describe here a 72-year-old man who presented with dysphagia due to the presence of a pyogenic granuloma. The tumor was located in the mid-esophagus and it was treated with endoscopic submucosal dissection. PG is considered a lesion of reactive origin that may develop in response to trauma, infection, pregnancy, angiogenic factors or hormones. Gastrointestinal PG need to be treated because it is a rare cause of gastrointestinal hemorrhage, and it is hard to differentiate from tumorous conditions such as Kaposi's sarcoma.
Aged ; Angiogenesis Inducing Agents ; Deglutition Disorders ; Fingers ; Gastrointestinal Hemorrhage ; Granuloma ; Granuloma, Pyogenic ; Hemangioma ; Humans ; Lip ; Mouth ; Mucous Membrane ; Pregnancy ; Skin

BACKGROUND AND OBJECTIVES: A cerebrospinal fluid (CSF) gusher during cochlear implantation can produce surgical difficulties and postoperative life threatening morbidities such as meningitis. Authors reviewed cases of CSF gushers during cochlear implantation, and assessed the radiologic characteristics of CSF gushers. SUBJECTS AND METHOD: From November 1988 to March 2004, 72 congenital deaf children with inner ear malformation underwent cochlear implantation in Seoul National University Hospital. Among these, 15 patients showed CSF gush intraoperatively. The medical records, the preoperative tem-poral bone HRCT and IAC MRI were reviewed retrospectively. RESULTS: Eighty percent (12/15) of CSF gushers had cochlear malformation. One case with a common cavity (100%), 6 of 15 cases of cochlear hypoplasia (32%) and 5 of 27 cases of incomplete partition (18.5%) showed CSF gush. The total or a partial defect of the modiolus significantly increased the risk of CSF gush. During the surgery, promontory mucosa around the cochleostomy opening was removed by electrocauterization and soft tissue pieces were packed in the posterior tympanum around the cochleostomy site after insertion of the active electrodes. Some additional procedures such as mastoid or middle ear obliteration were performed in two patients with intractable CSF gush. No lumbar drains were used. Postoperative meningitis developed in one case 7 months after cochlear implantation without a history of CSF leak. However, there were no evidences of CSF leak in all cases during the postoperative follow-up period (3-49 months, mean 24 months). CONCLUSION: Cochlear implant surgeons should be prepared to cope with CSF gusher during the cochlear implantation procedure in cases with congenital inner ear malformation, particularly if the patient has radiological evidence of modiolar defect.
Cerebrospinal Fluid* ; Child ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner ; Ear, Middle ; Electrodes ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Medical Records ; Meningitis ; Mucous Membrane ; Retrospective Studies ; Seoul

Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. Conclusion In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

BACKGROUND: With global trends in population aging, healthy aging has become a most important matter. Thus, many researchers are developing and implementing healthy aging methods to promote quality of life in the elderly. METHODS: This cross-sectional study was designed to assess health-related factors associated with nutritio- nal risks in the older population. 880 subjects(411males, 469females) living in Seongnam City, all over 65 yrs, were interviewed about their eating behaviors by well-trained nurses. Tests included anthropometric measurements, biochemistry, and visceral and subcutaneous fat measurements from abdominal CT scans. RESULTS: Mean BMI was 23.7+/-3.2kg/m2 in men and 24.2+/-3.4kg/m2 in women. The prevalence of diabetes mellitus and hypertension was 36.0% and 67.6%, respectively, for males and 31.3% and 72.7%, respectively, for females. Seen in this study, several aspects of human eating behavior may be relevant in identifying effective measures to prevent or treat metabolic risks. Increased subcutaneous fat was associated with overea- ting and irregular meals. Increased visceral fat was associated with overeating and having hurried meals (less than 20 minutes). BMI was influenced by frequent eating out, rapid food ingestion, and favoring spicy foods. CONCLUSION: Factors such as food choice and eating behavior affect the risk of obesity and cardiovascular accidents. Clinicians should recognize the importance between nutrition and health in the elderly. Our data suggest that good eating behavior reduces metabolic risks in the older population.
Aged ; Aging ; Biochemistry ; Cardiovascular Diseases ; Cross-Sectional Studies ; Diabetes Mellitus ; Eating ; Feeding Behavior ; Female ; Humans ; Hyperphagia ; Hypertension ; Intra-Abdominal Fat ; Longitudinal Studies ; Male ; Meals ; Obesity ; Prevalence ; Quality of Life ; Subcutaneous Fat ; Tolnaftate

BACKGROUND AND OBJECTIVES: Venous malformations are one of the most common vascular anomalies, and are more frequently found in head and neck region. Various treatment options are available, and intralesional injection of sclerosant is the commonest primary treatment modality. We reviewed 20 cases of venous malformation treated with sclerotherapy at Seoul National University Hospital. MATERIALS AND METHODS: Twenty cases of venous malformation in head and neck were reviewed retrospectively, which had been managed with sclerotherapy from January 1991 to July 2001. The patients were treated at the department of otolaryngology-Head and Neck Surgery or plastic surgery of Seoul National University Hospital. Emulsion of Ethamolin and Lipiodol was used as a sclerosing agent. Some patients received surgical treatment after sclerotherapy. All of the patients received direct-puncture venography(Digital subtraction angiography) before sclerotherapy. Treatment results were evaluated by using MRI, angiography, or CT. If the reduction of volume of mass was more than 50 percent after sclerotherapy, we regarded the result as effective, if less than 50 percents, non-effective. Statistical analysis was done using SPSS10.0 for windows. RESULTS: Among twenty patients, there were eight males(40%), and twelve females(60%). Ages at the beginning of treatment ranged from six to thirty-eight years(mean age:20.6 years). The most common site of lesions was cheek(in 12 cases). Mass sizes(largest diameter) ranged from 2 cm to 20 cm. Nine cases were managed with both sclerotherapy and surgical excision, and eleven cases, only with sclerotherapy. Thirteen cases(65%) responded well to sclerotherapy(volume reduction>or=50%). There was no major complication. Tenderness, induration, swelling, and pain were reported as post-sclerotherapy complaints. Mild dyspnea occurred in one case, and the patient was managed at ICU shortly without fatal event. CONCLUSION: Sclerotherapy with or without surgical excision was an effective treatment modality for venous malformation, with minimal risk of major complications. There were no significant differences in the treatment results according to the initial size of the lesions.
Angiography ; Dyspnea ; Ethiodized Oil ; Head ; Humans ; Injections, Intralesional ; Magnetic Resonance Imaging ; Neck ; Retrospective Studies ; Sclerotherapy* ; Seoul ; Surgery, Plastic

BACKGROUND/AIMS: Our clinical experience and recent published literatures suggest that Clostridium difficile colitis (CDC) has become more common and potentially more pathogenic in recent years. The aim of study was to evaluate changes in the epidemiological features of CDC in hospitalized patients in Korea. METHODS: We retrospectively reviewed all patients of CDC diagnosed at Kangnam St. Mary Hospital from 1998 to 2007. CDC was defined as having a positive C. difficile cytotoxicity assay, or endoscopic or pathologic evidence of CDC. RESULTS: A total of 189 cases (male 73, female 116, mean age 63.3 years) of CDC were diagnosed during the study period. The prevalence of CDC increased from 1.9/10,000 patient admissions in 1998-1999 to 8.82/10,000 patient admissions in 2006-2007. One hundred sixty three indication for cases (86.2%) of patients identified a prior use of antibiotics in the 2 months preceding diagnosis. The most common antibiotic use was prophylactic use during perioperational period (33.3%) followed by pneumonia (23.3%). The overall response rate to initial antibiotics was 82.7%. One hundred seventy two (91%) patients were initially treated with metronidazole. The response rate was 84.3%. All patients with initial failure to metronidazole were successfully treated by vancomycin. The response rate of vancomycin as first treatment was 80%. Three deaths were associated with CDC despite the use of combination of metronidazole and vancomycin. CONCLUSIONS: The prevalence of CDC in hospitalized patients in Korea significantly increased from 1998 to 2007.
Aged ; Anti-Bacterial Agents/therapeutic use ; *Clostridium difficile ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*epidemiology ; Female ; Humans ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Vancomycin/therapeutic use