Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

BACKGROUND/AIMS: For more than a decade, triple therapy (proton pump inhibitor, amoxicillin, clarithromycin) has been the first line eradication regimen for Helicobacter pylori infection in Korea. However, recent studies have proven that its' efficacy is no longer tolerable due to increased resistance of antibiotics. This study is aimed to investigate the current status of triple therapy, quadruple therapy and dual therapy as first line regimen for H. pylori infection in single medical center. MATERIALS AND METHODS: Medical records of patients who received urea breath test after first line eradication therapy from August 2011 to November 2014 were retrospectively analyzed. Patients were divided into three groups according to the first line treatment regimen; triple therapy (proton pump inhibitor (PPI)+clarithromycin+amoxicillin), quadruple therapy (PPI+bismuth+tetracycline+metronidazole), dual therapy (PPI+amoxicillin). RESULTS: A total of 557 patients were reviewed and 429 patients (77.0%) had successful eradication. Among 511 patients who received triple therapy, the eradication rates were 77.1% (394 patients). Eradication rates were 95.2% among quadruple therapy group. Dual therapy group had exceptionally low eradication rates (60.0%). CONCLUSIONS: Even though triple therapy has been recommended as first line regimen in Korea, eradication rates were below 80%. Quadruple therapy as first line regimen showed promising future reaching over 90% eradication rates. However, due to the small number of patients in our study, further studies are necessary to estimate usefulness of quadruple therapy as first line regimen.
Amoxicillin ; Anti-Bacterial Agents ; Breath Tests ; Helicobacter pylori* ; Humans ; Korea ; Medical Records ; Retrospective Studies ; Urea

Bisphenol A (BPA) has been reported to possess hepatic toxicity. We investigated the hypothesis that BPA, below the no observed adverse effect level (NOAEL), can induce hepatic damage and mitochondrial dysfunction by increasing oxidative stress in the liver. Two doses of BPA, 0.05 and 1.2 mg/kg body weight/day, were administered intraperitoneally for 5 days to mice. Both treatments impaired the structure of the hepatic mitochondria, although oxygen consumption rate and expression of the respiratory complex decreased only at the higher dose. The hepatic levels of malondialdehyde (MDA), a naturally occurring product of lipid peroxidation, increased, while the expression of glutathione peroxidase 3 (GPx3) decreased, after BPA treatment. The expression levels of proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) also increased. In HepG2 cells, 10 or 100 nM of BPA also decreased the oxygen consumption rate, ATP production, and the mitochondrial membrane potential. In conclusion, doses of BPA below the NOAEL induce mitochondrial dysfunction in the liver, and this is associated with an increase in oxidative stress and inflammation.
Adenosine Triphosphate/metabolism ; Animals ; Glutathione Peroxidase/metabolism ; Hep G2 Cells ; Humans ; Inflammation/chemically induced/metabolism/pathology ; Injections, Intraperitoneal ; Interleukin-6/metabolism ; Lipid Peroxidation/drug effects ; Liver/*drug effects/metabolism/pathology ; Male ; Malondialdehyde/metabolism ; Membrane Potential, Mitochondrial/drug effects ; Mice ; Mice, Inbred C57BL ; Mitochondria/drug effects/*metabolism ; Oxidative Stress/drug effects ; Oxygen Consumption/drug effects ; Phenols/*toxicity ; Tumor Necrosis Factor-alpha/metabolism

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

The branchio-oto-renal (BOR) syndrome is a clinically and genetically heterogeneous disease entity which is characterized by the association of preauricular pits, branchial cleft anomaly, hearing loss and various renal anomalies. The incidence of BOR syndrome is approximately 1 : 40,000 and its genetic pattern of transmission is autosomal dominant. Hearing loss is the most common feature of BOR syndrome and is reported in almost 90% of affected individuals. EYA1, the human homologue of the Drosophila eyes absent gene, has been shown to cause BOR syndrome. We report, with a review of literatures, a female patient with BOR syndrome.
Branchial Region ; Branchio-Oto-Renal Syndrome ; Drosophila ; Eye ; Female ; Hearing Loss ; Humans ; Incidence

Amelogenesis Imperfecta ; Amelogenesis ; Dental Caries ; Dental Enamel ; Genetic Diseases, Inborn ; Humans ; Malocclusion ; Orthognathic Surgery ; Prosthodontics ; Tooth ; Vertical Dimension

Lymphocytic interstitial pneumonia(LIP) is an uncommon condition in which the alveolar septa and extra-alveolar interstitial space are markedly expanded by small lymphocytes, plasma cells and histiocytes. Chest radiographs generally show nonspecific patterns with the most common pattern showing bibasilar reticular or reticulonodular infiltrates. Hilar or mediastinal lymphadenopathy and pleural effusions are usually absent. We encountered a 42-year-old female patient who was admitted to hospital because of exertional dyspnea and palpitation. The chest X-ray showed an enlarged bilateral hilar shadow and diffusely increased bronchovascular markings in both lung fields. The chest CT showed diffuse nodular infiltrations with mild septal thickening and combined patchy ground glass opacity in both lungs, and conglomerated mediastinal and bilateral hilar lymphadenopathy. A diagnosis of LIP was made from the tissue pathology taken by a thoracoscopic lung biopsy. The patient showed clinical and radiographic improvement after 3 months of treatment with prednisolone. We report a case of LIP presenting as diffuse nodular interstitial infiltrations with multiple mediastinal and bilateral hilar lymphadenopathy.
Adult ; Biopsy ; Diagnosis ; Dyspnea ; Female ; Glass ; Histiocytes ; Humans ; Lip ; Lung ; Lymphatic Diseases* ; Lymphocytes ; Pathology ; Plasma Cells ; Pleural Effusion ; Prednisolone ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed

PURPOSE: To investigate the efficacy of amniotic membrane transplantation (AMT) in patients who were diagnosed with necrotizing scleritis after pterygium excision and who were refractory to systemic corticosteroid and immunosuppressive therapy. METHODS: Six patients who had persistent scleral melting with systemic corticosteroid or immunosuppressive agents underwent double AMT as a permanent patch graft and temporary overlying barrier. Postoperatively, the symptom improvements, reepithelization times and visual acuity changes were evaluated. RESULTS: Choroidal detachment was detected in two patients preoperatively. In all patients, ocular pain improved at 4.7 +/- 3.1 days, and reepithelization of the scleral lesions was completed at 13.2 +/- 8.1 days postoperatively. Choroidal detachment in two patients disappeared at postoperative 2 and 8 days. Complete remission was found in 5 of the 6 eyes (83.3%). One eye which achieved full epithelization in the necrotic area experienced recurrent nodular scleritis in another quadrant, resulting in remission after changing the regimen of immunosuppressive agents. Mean values of initial and final visual acuities were 0.898 logMAR and 0.428 logMAR, respectively, and the visual acuities improved in all patients. CONCLUSIONS: AMT is effective in promoting reepithelization of the necrotic area, resulting in complete remission of necrotizing scleritis in patients who were refractory to systemic corticosteroid or immunosuppressive therapy.
Amnion* ; Choroid ; Freezing ; Humans ; Immunosuppressive Agents ; Pterygium* ; Scleritis* ; Transplants ; Visual Acuity

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

BACKGROUND: Recent evidence indicates that elevated COX-2 expression is associated with the carcinogenesis of numerous neoplasms. In this study, we investigated COX-2 expression in various thyroid specimens in order to elucidate its physiological role in pathologic conditions, and to evaluate the efficiency of COX-2 protein expression as a molecular marker of malignancy in the thyroid gland. METHODS: COX-2 expression was studied immunohistochemically in 19 papillary carcinomas, 8 follicular carcinomas, 14 follicular adenomas, 2 H rthle cell carcinomas, 4 H rthle cell adenomas, 8 nodular hyperplasias, 3 Graves' diseases, 3 Hashimoto's thyroiditis, 2 medullary carcinomas, 1 anaplastic carcinoma, and 20 normal thyroid tissues. RESULTS: COX-2 staining was not seen in any of the normal thyroid, Graves' disease, or nodular hyperplasia specimens. In contrast, COX-2 staining was observed in all of papillary carcinomas, Hashimoto's thyroiditis, H rthle cell carcinomas, and H rthle cell adenomas tissues. Moreover, 7 of 8 follicular carcinomas and 11 of 14 follicular adenomas showed COX-2 staining. CONCLUSION: These results indicate that COX-2 is not useful as a marker of malignancy. Since COX-2 expression was evident in follicular adenomas and in papillary and follicular carcinomas. Thus, the enzyme may be involved in the early process of thyroid tumorigenesis.
Human ; *Immunohistochemistry ; Isoenzymes/*analysis ; Prostaglandin-Endoperoxide Synthase/*analysis ; Thyroid Nodule/*enzymology/*pathology ; Tumor Markers, Biological/*analysis