BACKGROUND AND OBJECTIVES: This study aimed to analyze the prevalence of superior semicircular canal dehiscence (SSCD) in the coronal images of high-resolution temporal bone computed tomography (TBCT) and to evaluate the diagnostic accuracy of coronal images for SSCD syndrome. SUBJECTS AND METHOD: We retrospectively reviewed high-resolution TBCT scans of 217 patients (434 ears) with SSCD due to various causes. The dehiscence ratio (slices showing dehiscence/total slices showing the superior semicircular canal) in the coronal images of TBCT was calculated, and the optimal cutoff value for the diagnosis of SSCD syndrome was determined using the receiver operating characteristics (ROC) curve. RESULTS: Of the 434 ears, 64 (14.7%) presented SSCD in more than one slice of the coronal images of TBCT, but only three patients (0.7%) were confirmed with SSCD syndrome. Based on the ROC curve analysis for the dehiscence ratio of 64 ears, the optimal cutoff value for the diagnosis of SSCD syndrome was 0.67 with 100% sensitivity and 90.2% specificity. CONCLUSION: The majority of cases diagnosed with SSCD syndrome using the coronal images of TBCT were asymptomatic or false-positive. The dehiscence ratio in the coronal images of TBCT combined with a typical symptom can be a highly sensitive and specific diagnostic tool for SSCD syndrome.
Diagnosis ; Ear ; Humans ; Methods ; Prevalence* ; Retrospective Studies ; ROC Curve ; Semicircular Canals* ; Sensitivity and Specificity ; Temporal Bone*

PURPOSE: To construct new Korean reference curves for birth weight by sex and gestational age using contemporary Korean birth weight data and to compare them with the Lubchenco and the 2010 United States (US) intrauterine growth curves. METHODS: Data of 2,336,727 newborns by the Korean Statistical Information Service (2008-2012) were used. Smoothed percentile curves were created by the Lambda Mu Sigma method using subsample of singleton. The new Korean reference curves were compared with the Lubchenco and the 2010 US intrauterine growth curves. RESULTS: Reference of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles birth weight by gestational age were made using 2,249,804 (male, 1,159,070) singleton newborns with gestational age 23-43 weeks. Separate birth weight curves were constructed for male and female. The Korean reference curves are similar to the 2010 US intrauterine growth curves. However, the cutoff values for small for gestational age (<10th percentile) of the new Korean curves differed from those of the Lubchenco curves for each gestational age. The Lubchenco curves underestimated the percentage of infants who were born small for gestational age. CONCLUSION: The new Korean reference curves for birth weight show a different pattern from the Lubchenco curves, which were made from white neonates more than 60 years ago. Further research on short-term and long-term health outcomes of small for gestational age babies based on the new Korean reference data is needed.
Asian Continental Ancestry Group ; Birth Weight* ; Female ; Gestational Age* ; Growth Charts ; Humans ; Infant ; Infant, Newborn ; Information Services* ; Male ; United States

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is a very common disorder world-wide and gastroesophageal reflux disease (GERD) is known to be the most common cause. The prevalence of NCCP may tend to decrease with increasing age. However, there is little report about young aged NCCP. The aim of this study was to examine the prevalence of GERD and to evaluate the efficacy of proton pump inhibitor (PPI) test in the young NCCP patients. METHODS: Thirty patients with at least weekly NCCP less than 40 years were enrolled. The baseline symptoms were assessed using a daily symptom diary for 14 days. Esophago-gastro-duodenoscopy (EGD) and 24 hr esophageal pH monitoring were performed for the diagnosis of GERD and esophageal manometry was done. Then, patients were tried with lansoprazole 30 mg twice daily for 14 days, considering positive if a symptom score improved > or = 50% compared to the baseline. RESULTS: Nine (30%) of the patients were diagnosed with GERD at EGD and/or 24 hr esophageal pH monitoring, also, 3 (10%) were diagnosed with GERD-associated esophageal motility disorder and 3 (10%) were non GERD-associated. Concerning PPI test, GERD-related NCCP had a higher positive PPI test (n = 8, 89%) than non GERD-related NCCP (n = 5, 24%) (p = 0.002). CONCLUSIONS: In young patients with NCCP, a prevalence of GERD diagnosed using EGD and/or 24 hr esophageal pH monitoring was 30%. PPI test was very predictable on diagnosis of GERD-related NCCP, thus, PPI test in young NCCP patients may assist to the physician's clinical judgment of NCCP.
2-Pyridinylmethylsulfinylbenzimidazoles ; Aged ; Chest Pain ; Esophageal Motility Disorders ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Judgment ; Manometry ; Prevalence ; Proton Pumps ; Thorax ; Young Adult

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of the paranasal sinus is rare. It is usually secondary to the extension of disease from adjacent bones and rarely limited to the sinuses. The purpose of this study is to get an improved appreciation of the clinical features and courses of fibrous dysplasia involving paranasal sinuses. SUBJECTS AND METHOD: Medical records of 15 patients diagnosed as fibrous dysplasia involving paranasal sinuses from 1990 to 2004 were reviewed retrospectively. Clinical informations including age of diagnosis, presenting symptoms, radiographic findings, treatment and clinical outcome for each patient were analyzed. The male to female ratio was 7 : 8. Their ages ranged from 7 to 68 with the median of 32. Seven patients were younger than 30 years old at presentation. RESULTS: The most common complaint was headache followed by facial swelling. The mean duration of illness was 11 months. In the findings of CT, eight patients belonged to the sclerotic type, six to the pagetoid type, and one the tocystic type. Eight patients were polyostotic while the others were monostotic. The most commonly involved sinus was the sphenoid sinus followed by ethmoid sinus. Seven patients who had facial swelling, exophthalmos or nasal obstruction underwent surgery, and in four of them, the lesion was in progression or recurred. Lesions in eight patients who were older than 30 years old and had no symptoms except headache did not progress thereafter. CONCLUSION: The progression of fibrous dysplasia stops when the bony growth is completed. Thus, if the patients are diagnosed with fibrous dysplasia over the age of 30 and do not have specific symptoms, there may be no need for surgical treatment.
Adult ; Diagnosis ; Ethmoid Sinus ; Exophthalmos ; Female ; Headache ; Humans ; Male ; Medical Records ; Nasal Obstruction ; Paranasal Sinuses* ; Retrospective Studies ; Sphenoid Sinus

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) is commonly sub-classified into seasonal and perennial rhinitis. The recent "Allergic Rhinitis and its impact on Asthma (ARIA) Workshop" proposed to replace these terms by intermittent vs persistent AR. But the validity of this new classification is still largely unknown. SUBJECTS AND METHOD: Three hundred-eleven allergic rhinitis patients were included in this study. Patients were categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups, according to sensitized allergens. Twenty-eight items questionnaire filled out by patients were designed for this study. Based on the questionnaire, patients were classified into either intermittent or persistent AR. Patients' information and associated factors were analysed between the groups. RESULTS: Within the population with AR, 58% of the subjects had persistent AR. About 41% of the patients were classified as moderate-severe persistent AR. There was no association between the intermittent/persistent and the SAR/PAR classifications. Subjects with persistent AR had more severe symptoms, higher rate of self-awareness and had been previously diagnosed with AR. There were no significant difference in sensitization to allergens. However, grass, tree, house dust mite allergy is more common in persistent AR than in intermittent AR. More patients in "Blockers" and "Mixed" groups had persistent AR. CONCLUSION: A statistical comparison of the two classifications showed that they cannot be used interchangeably, as they do not represent the same stratum of disease. There is also an evidence that the persistent type describes a distinct group with characteristics that differentiates them from intermittent AR. These results support the validity of the new ARIA classification as shown in other studies.
Allergens ; Asthma ; Classification* ; Humans ; Hypersensitivity ; Poaceae ; Prevalence* ; Pyroglyphidae ; Surveys and Questionnaires ; Rhinitis* ; Rhinitis, Allergic, Seasonal ; Seasons

BACKGROUND AND OBJECTIVES: Mucociliary movement of respiratory ciliated epithelium is one of important protective mechanisms in the upper respiratory airway. It is well known that methacholine induces a ciliostimulation. This study designed to investigate the regulatory mechanism of methacholine induced ciliostimulation. MATERIALS AND METHOD: We investigated in vitro effect of methacholine, a beta-methyl ester of acetylcholine, and nitric oxide on ciliary beat frequency (CBF) of nasal septal mucosa of SD rat. CBF was measured using a video computerized analysis system. RESULTS: Methacholine (10(-6) mol/L) increased CBF upto 6 hours with a maximum increase of 44%. Diclofenac inhibited the ciliostimulatory effect of methacholine completely. LNAME inhibited the increase in CBF by methacholine significantly (p<.05). CONCLUSION: The results suggest that ciliostimulatory effects by methacholine in airway epithelium involves prostaglandin pathway and may be regulated by nitric oxide.
Acetylcholine ; Animals ; Diclofenac ; Epithelium ; Methacholine Chloride* ; Mucociliary Clearance ; Mucous Membrane ; Nitric Oxide* ; Prostaglandin-Endoperoxide Synthases* ; Rats

BACKGROUND AND OBJECTIVES: Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon tumor with poorer prognosis compared with its cutaneous counterpart. The purpose of this study is to investigate the clinical features and treatment outcomes of mucosal malignant melanoma of the nasal cavity and paranasal sinuses. SUBJECTS AND METHOD: Eighteen patients who were diagnosed and treated as mucosal malignant melanoma of nasal cavity and paranasal sinuses from 1995 to 2004 were included. Male to female ratio was 10 to 8. Their ages ranged from 43 to 87 years with median of 62 years. The medical records were reviewed retrospectively with respect to presenting symptoms, stage, treatment modalities and outcome. RESULT: The most common symptoms were epistaxis and nasal obstruction. The mean duration of symptom was 4.2 months. Commonly involved sites were middle turbinate, inferior turbinate, maxillary sinus and ethmoid sinus. Eight cases belonged to stage I, nine cases to stage II and only one case to stage III. Among them, seventeen patients underwent surgery with or without radiotherapy and immunotherapy. Of the seventeen patients who underwent surgery, twelve had recurrence and the mean period for recurrence was 8.2 months. During the follow-up periods, five had distant metastases. Five-year survival rate was 27.2% and the survival rates according to age, sex, tumor size and stage were not statistically significant. CONCLUSION: Mucosal malignant melanomas of the nasal cavity and paranasal sinuses developed commonly in the 6th to 8th decades. Epistaxis and nasal obstruction were the most common presenting symptoms. Almost all cases belonged to the stage I or II and the mainstay of the treatment was surgery. However, it was associated with frequent recurrences and a poor prognosis.
Epistaxis ; Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Immunotherapy ; Male ; Maxillary Sinus ; Medical Records ; Melanoma* ; Nasal Cavity* ; Nasal Obstruction ; Neoplasm Metastasis ; Paranasal Sinuses* ; Prognosis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Turbinates

BACKGROUND AND OBJECTIVES: Many surgical techniques are used for the treatment of nasopharyngeal angiofibroma (NAF). This study aimed to analyze the clinical features of NAF and treatment results according to the surgical modalities. MATERIALS AND METHODS: Twenty-five patients with NAF treated at Seoul National University Hospital from January 1990 through December 2004, were analyzed retrospectively by treatment modalities. RESULTS: According to the Sesson staging system, there were 9 patients with type I, 14 with type II, and 2 with type III. Of the 24 patients treated with surgery, there were 7 cases with pure endoscopic surgery and 17 cases with external approaches including 3 transpalatal approach, 5 midfacial degloving approach, 7 transantral approach, and 2 Le Fort I approach. Endoscope-assisted surgery was performed in 6 out of 17 cases who were treated with external approaches. Until 1996, external approaches were conducted in 12 out of 13 cases. Since 1997, pure endoscopic surgery was the most common approach, with 7 out of 12 cases, and it was applied especially in cases below stage IIA. Endoscopeassisted surgery was adjunct to all external techniques since 1997, with 5 out of 5 cases, and it was even applied in advanced cases over stage IIB . All 25 cases were treated successfully without any recurrence or mortality with surgery or radiation therapy. CONCLUSION: Treatment outcomes of pure endoscopic surgery are acceptable compared to those of traditional external approaches with reduced invasiveness and morbidity if proper selection is made depending on the tumor extent. Endoscope-assisted surgery can be helpful in all external approaches to improve visualization, even in advanced lesions.
Angiofibroma* ; Endoscopes ; Humans ; Mortality ; Recurrence ; Retrospective Studies ; Seoul

PURPOSE: Firstly, to analyze factors in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma. Secondly, to explore an effective salvage treatment for these relapses. MATERIALS AND METHODS: Two patients who had high-risk disease (T3bM1, T3bM3) were treated with combined chemoradiotherapy. CT-simulation based radiation-treatment planning (RTP) was performed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. RESULTS: Review of radiotherapy portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume. When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. CONCLUSION: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
Brain ; Chemoradiotherapy ; Craniospinal Irradiation ; Humans ; Medulloblastoma* ; Optic Nerve ; Radiotherapy ; Recurrence*

Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome, typically characterized by multiple colorectal adenomas and increased incidence of colorectal carcinomas if left untreated. It is caused by germline mutations of the adenomatous polyposis coli (APC) gene, which has been mapped on chromosome 5q21, and is accompanied by various benign and malignant extracolonic manifestations. The prevalence of thyroid tumors developing in patients with FAP is about 1~2%, are associated with FAP and have certain characteristics; mean age of tumor diagnosis at less than 30 years of age, the pathology is the papillary histiotype in more than 90% of cases, including a so-called cribriform- morular pattern, and multifocality is a frequent feature. In a genetic analysis, thyroid cancer in FAP usually has a mutation in the 5-portion of exon 15 between 778 and 1309, on chromosome 5q21. Also, the ret/PTC (especially ret/PTC1 and ret/PTC3) and p53 genes are thought probably to be associated with thyroid cancer in FAP patients. A case of familial adenomatous polyposis, accompanied by thyroid papillary cancer, was experienced in a 29 year-old female. She had hundreds of adenomas throughout the entire colon and congenital hypertrophy of the retinal pigment epithelium (CHRPE). The pathological finding of thyroid cancer was revealed as a mixture of cribriform, trabecular and papillary patterns. In a genetic analysis, she and her brother had a germline mutation of the APC gene at codon 1309. In Korea, there has been no previous case of cribriform-morular pattern and familial genetic analysis in FAP associated with thyroid cancer. Therefore, this case is reported, with a review of the literature
Adenoma ; Adenomatous Polyposis Coli* ; Adult ; Codon ; Colon ; Colorectal Neoplasms ; Diagnosis ; Exons ; Female ; Genes, APC ; Genes, p53 ; Germ-Line Mutation ; Humans ; Hypertrophy ; Incidence ; Korea ; Pathology ; Prevalence ; Retinal Pigment Epithelium ; Siblings ; Thyroid Gland* ; Thyroid Neoplasms