A congenital defect of the anterior wall of the external auditory canal (EAC) is known as foramen of Huschke. The tympanic bone is incompletely developed and has a U shape at birth. The foramen of Huschke closes via continuous bone growth, which occurs before the age of 5 years. A persistent foramen of Huschke is an anatomic variation located in the anteroinferior portion of EAC, which can cause ear discomfort with spontaneous temporomandibular joint (TMJ) herniation into the EAC bony defect. We present a case of 50-year-old man who had a symptomatic TMJ herniation through an osseous defect. The physical examination showed a bulging mass of anterioinferior portion of EAC when the patient closed his mouth, which was retracted when the mouth openned. We report a case of surgical reconstruction of the EAC wall defect, and the foramen of Huschke with titanium mesh via preauricular approach along with literature’s review.

BACKGROUND: Various systemic agents have been assessed for the treatment of alopecia areata (AA); however, there is a paucity of comparative studies. OBJECTIVE: To assess and compare cyclosporine and betamethasone minipulse therapy as treatments for AA with regard to effectiveness and safety. METHODS: Data were collected from 88 patients who received at least 3 months of oral cyclosporine (n=51) or betamethasone minipulse therapy (n=37) for AA. Patients with ≥50% of terminal hair regrowth in the alopecic area were considered responders. RESULTS: The responder of the cyclosporine group was 54.9% and that of the betamethasone minipulse group was 37.8%. In the cyclosporine group, patients with mild AA were found to respond better to the treatment. Based on the patient self-assessments, 70.6% of patients in the cyclosporine group and 43.2% of patients in the betamethasone minipulse group rated their hair regrowth as excellent or good. Side effects were less frequent in the cyclosporine group. CONCLUSION: Oral cyclosporine appeared to be superior to betamethasone minipulse therapy in terms of treatment effectiveness and safety.
Alopecia Areata* ; Alopecia* ; Betamethasone* ; Cyclosporine* ; Hair ; Humans ; Pulse Therapy, Drug ; Self-Assessment ; Treatment Outcome

We investigated how the dual inhibition of the molecular mechanism of the mammalian target of the rapamycin (mTOR) downstreams, P70S6 kinase (P70S6K) and eukaryotic initiation factor 4E (eIF4E), can lead to a suppression of the proliferation and progression of urothelial carcinoma (UC) in an orthotopic mouse non-muscle invasive bladder tumor (NMIBT) model. A KU-7-luc cell intravesically instilled orthotopic mouse NMIBC model was monitored using bioluminescence imaging (BLI) in vivo by interfering with different molecular components using rapamycin and siRNA technology. We then analyzed the effects on molecular activation status, cell growth, proliferation, and progression. A high concentration of rapamycin (10 microM) blocked both P70S6K and elF4E phosphorylation and inhibited cell proliferation in the KU-7-luc cells. It also reduced cell viability and proliferation more than the transfection of siRNA against p70S6K or elF4E. The groups with dual p70S6K and elF4E siRNA, and rapamycin reduced tumor volume and lamina propria invasion more than the groups with p70S6K or elF4E siRNA instillation, although all groups reduced photon density compared to the control. These findings suggest that both the mTOR pathway downstream of eIF4E and p70S6K can be successfully inhibited by high dose rapamycin only, and p70S6K and Elf4E dual inhibition is essential to control bladder tumor growth and progression.
Animals ; Cell Line ; Cell Proliferation/drug effects/genetics ; Cell Survival/drug effects ; Disease Progression ; Eukaryotic Initiation Factor-4E/*antagonists & inhibitors/genetics ; Female ; Mice ; Mice, Nude ; Mucous Membrane/pathology ; Phosphorylation/drug effects ; RNA Interference ; RNA, Small Interfering ; Ribosomal Protein S6 Kinases, 70-kDa/*antagonists & inhibitors/genetics ; Signal Transduction/drug effects ; Sirolimus/*pharmacology ; TOR Serine-Threonine Kinases/*antagonists & inhibitors/metabolism ; Urinary Bladder Neoplasms/genetics/*pathology ; Urothelium/pathology

We investigated how the dual inhibition of the molecular mechanism of the mammalian target of the rapamycin (mTOR) downstreams, P70S6 kinase (P70S6K) and eukaryotic initiation factor 4E (eIF4E), can lead to a suppression of the proliferation and progression of urothelial carcinoma (UC) in an orthotopic mouse non-muscle invasive bladder tumor (NMIBT) model. A KU-7-luc cell intravesically instilled orthotopic mouse NMIBC model was monitored using bioluminescence imaging (BLI) in vivo by interfering with different molecular components using rapamycin and siRNA technology. We then analyzed the effects on molecular activation status, cell growth, proliferation, and progression. A high concentration of rapamycin (10 microM) blocked both P70S6K and elF4E phosphorylation and inhibited cell proliferation in the KU-7-luc cells. It also reduced cell viability and proliferation more than the transfection of siRNA against p70S6K or elF4E. The groups with dual p70S6K and elF4E siRNA, and rapamycin reduced tumor volume and lamina propria invasion more than the groups with p70S6K or elF4E siRNA instillation, although all groups reduced photon density compared to the control. These findings suggest that both the mTOR pathway downstream of eIF4E and p70S6K can be successfully inhibited by high dose rapamycin only, and p70S6K and Elf4E dual inhibition is essential to control bladder tumor growth and progression.
Animals ; Cell Line ; Cell Proliferation/drug effects/genetics ; Cell Survival/drug effects ; Disease Progression ; Eukaryotic Initiation Factor-4E/*antagonists & inhibitors/genetics ; Female ; Mice ; Mice, Nude ; Mucous Membrane/pathology ; Phosphorylation/drug effects ; RNA Interference ; RNA, Small Interfering ; Ribosomal Protein S6 Kinases, 70-kDa/*antagonists & inhibitors/genetics ; Signal Transduction/drug effects ; Sirolimus/*pharmacology ; TOR Serine-Threonine Kinases/*antagonists & inhibitors/metabolism ; Urinary Bladder Neoplasms/genetics/*pathology ; Urothelium/pathology

We found an error in our published article.

We established an orthotopic non-muscle invasive bladder cancer (NMIBC) mouse model expressing the mammalian target of the rapamycin (mTOR) signaling pathway. After intravesical instillation of KU-7-lucs (day 0), animals were subsequently monitored by bioluminescence imaging (BLI) on days 4, 7, 14, and 21, and performed histopathological examination. We also validated the orthotopic mouse model expressing the mTOR signaling pathway immunohistochemically. In vitro BLI photon density was correlated with KU-7-luc cell number (r2 = 0.97, P < 0.01) and in vivo BLI photon densities increased steadily with time after intravesical instillation. The tumor take rate was 84.2%, formed initially on day 4 and remained NMIBC up to day 21. T1 photon densities were significantly higher than Ta (P < 0.01), and histological tumor volume was positively correlated with BLI photon density (r2 = 0.87, P < 0.01). The mTOR signaling pathway-related proteins were expressed in the bladder, and were correlated with the western blot results. Our results suggest successful establishment of an orthotopic mouse NMIBC model expressing the mTOR signaling pathway using KU-7-luc cells. This model is expected to be helpful to evaluate preclinical testing of intravesical therapy based on the mTOR signaling pathway against NMIBC.
Animals ; Blotting, Western ; Cell Line, Tumor ; Disease Models, Animal ; Female ; Genes, Reporter ; Green Fluorescent Proteins/genetics/metabolism ; Humans ; Immunohistochemistry ; Luciferases, Firefly/genetics ; Luminescent Measurements ; Mice ; Mice, Nude ; Neoplasm Staging ; *Signal Transduction ; TOR Serine-Threonine Kinases/*metabolism ; Transplantation, Heterologous ; Urinary Bladder Neoplasms/*metabolism/pathology/veterinary

PURPOSE: The aim of this study was to evaluate the effectiveness of simultaneous flexible ureteroscopic removal of stones (URS) for ureteral and ipsilateral renal stones and to analyze the predictive factors for renal stone-free status. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent simultaneous flexible URS of ureteral and ipsilateral renal stones from January 2010 to May 2012. All operations used a flexible ureteroscope. We identified 74 cases of retrograde intrarenal surgery and 74 ureteral stones (74 patients). Stone-free status was respectively defined as no visible stones and clinically insignificant residual stones <3 mm on a postoperative image study. Predictive factors for stone-free status were evaluated. RESULTS: The immediate postoperative renal stone-free rate was 70%, which increased to 83% at 1 month after surgery. The immediate postoperative ureteral stone-free rate was 100%. Among all renal stones, 15 (20.3%) were separately located in the renal pelvis, 11 (14.8%) in the upper calyx, 15 (20.3%) in the mid calyx, and 33 (44.6%) in the lower calyx. The mean cumulative stone burden was 92.22+/-105.75 mm2. In a multivariate analysis, cumulative stone burden <100 mm2 was a significant predictive factor for postoperative renal stone-free status after 1 month (p<0.01). CONCLUSIONS: Flexible URS can be considered simultaneously for both ureteral and renal stones in selected patients. Flexible URS is a favorable option that promises high stone-free status without significant complications for patients with a stone burden <100 mm2.
Humans ; Kidney Calculi ; Kidney Pelvis ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Treatment Outcome ; Ureter ; Ureteroscopes

PURPOSE: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we couldimprove the financial balance of the trauma center. METHODS: Retrospective analysis was performed on patients visitingSNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. RESULTS: The 31 patients in this study included 20 males and 11 females. The average ISS was 33.23+/-16.65 points.We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The averagehospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. CONCLUSION: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.
Budgets ; Emergencies ; Fees and Charges ; Fees, Medical ; Female ; Humans ; Injury Severity Score ; Intensive Care Units ; Length of Stay ; Male ; Retrospective Studies ; Trauma Centers

There have been 5 case reports about immune hemolytic anemia related with cimetidine, but there has been no such report in Korea. A sixty-four-year-old woman was admitted to the emergency department in a coma. She was diagnosed with diffuse large B-cell lymphoma 5 years ago and she achieved a complete remission after treatment. She was in a state of shock, and her blood pressure was 70/40 mmHg. The laboratory test results were consistent with hemolytic anemia (HA) as follows: hemoglobin: 1.9 g/dL, corrected reticulocyte count: 2%, total/conjugated bilirubin: 6.4/2.1 mg/dL, lactate dehydrogenase: 1,083 U/L and haptoglobin <10 mg/dL. She had a history of taking the drugs including cimetidine, acetaminophen and etizolam for two days. She urgently received transfusion of 3 units of packed red blood cells and then she regained consciousness. To investigate the relation between cimetidine and HA, we subsequently performed a drug-induced immune complex test and an antibody test by using cimetidine, AB serum and phosphate-buffered saline. The results proved that cimetidine was the cause of the HA. Patient was treated with steroid, and the following laboratory tests showed rapid improvement. This is the first case report from Korea that shows the causal relationship between cimetidine and immune HA.
Acetaminophen ; Anemia, Hemolytic ; Antigen-Antibody Complex ; Blood Pressure ; Cimetidine ; Coma ; Consciousness ; Diazepam ; Emergencies ; Erythrocytes ; Female ; Haptoglobins ; Humans ; Korea ; Lactic Acid ; Lymphoma, B-Cell ; Reticulocytes ; Shock

Good's syndrome (thymoma with immunodeficiency) is a rare cause of combined B-cell and T-cell immunodeficiency in adults. We present here a case of Good's syndrome involving a 52 year-old man with an ABO blood group abnormality. He had undergone surgery for thymoma with myasthenia gravis 27 years ago. He also had a history of pulmonary tuberculosis, herpes zoster and pure red cell aplasia. On admission, he was suspected of having pneumonia, and S. pneumoniae was isolated from blood culture. The immunoglobulin levels were markedly decreased. Lymphocyte subset analysis revealed the absence of CD19+ B cells. The result of ABO typing showed a normal strong reaction on the cell typing, but a relatively weak reaction on the serum typing. Therefore, we performed ABO genotyping to confirm his ABO type, which was revealed to be B/O1 . This case suggests that ABO typing should be performed when the diagnosis of Good's syndrome is made. Moreover, Good's syndrome (thymoma with hypogammaglobulinemia) should be considered and evaluated for in patients with a weak ABO reverse type.
Adult ; B-Lymphocytes ; Herpes Zoster ; Humans ; Immunoglobulins ; Lymphocyte Subsets ; Myasthenia Gravis ; Pneumonia ; Red-Cell Aplasia, Pure ; T-Lymphocytes ; Thymoma ; Tuberculosis, Pulmonary