Churg-Strauss syndrome is a rare systemic vasculitis occurring in patients with asthma and peripheral eosinophilia. Lungs, skin, and the nervous system are the most common sites of involvement, although many other organs are affected frequently. We report a case of 54-year-old male with a history of asthma and chronic rhinosinusitis who was admitted to the emergency department because of dyspnea and pleural pain. He was diagnosed with Churg-Strauss syndrome based on bronchial asthma, peripheral eosinophilia, pulmonary infiltration, chronic rhinosinusitis, and extravascular eosinophil infiltration. His symptoms were resolved dramatically after treatment with corticosteroids. Allergic rhinitis and chronic rhinosinusitis with or without polyps may be present at the early stage of Churg-Strauss syndrome. Therefore, otolaryngologists may play a pivotal role in making an early diagnosis of this disease.
Adrenal Cortex Hormones ; Asthma ; Churg-Strauss Syndrome* ; Dyspnea ; Early Diagnosis ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils ; Humans ; Lung ; Male ; Middle Aged ; Nasal Cavity* ; Nervous System ; Polyps ; Pulmonary Eosinophilia ; Rhinitis ; Skin ; Systemic Vasculitis ; Vasculitis

BACKGROUND AND OBJECTIVES: Before the introduction of transnasal endoscopic sinus surgery, transorbital approach with an external incision used to be one of the representative reconstructive surgical repairing method of blow out fracture. The important advantages of transnasal endoscopic technique are magnified direct visualization and easy accessibility to the medial orbital wall. Nasopore Forte(R) is a slowly absorbable material and provides excellent durability. The purpose of this study is to evaluate outcomes of endoscopic endonasal reduction (EER) of medial blow out fracture using Nasopore Forte(R). SUBJECTS AND METHOD: A retrospective study was performed on 26 patients with medial blowout fracture who had undergone EER using Nasopore Forte(R) from January to December of 2010 at our clinic. A review of medical records included demographic data, preoperative ocular symptoms and signs, and surgical outcomes including postoperative symptom improvement and complications. RESULTS: Of 26 patients, 5 had persistent diplopia, 5 enophthalmos, and 3 both diplopia and enophthalmos preoperatively. Seventeen patients were asymptomatic, but had large defects with the mean defect size of 2.4 cm2. Postoperative computed tomography scan showed excellent (22) to good (4) reduction. Preoperative symptoms were resolved in all of 13 symptomatic patients and there was no enophthalmos during the follow-up period. No significant complications including sinusitis or synechia were found. CONCLUSION: EER is a highly effective and safe procedure for the reduction of medial blow out fracture. Nasopore Forte(R) is easy to handle and can be tailored to individual defects, and is useful for securing the reduction and preventing adhesion after EER.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Medical Records ; Orbit ; Retrospective Studies ; Sinusitis

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

Colonic lipomas represent mesenchymal origin tumors that are second most common benign colonic tumor after hyperplastic polyps and adenomatous polyps. The patho-genesis of them is not clear. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation, and autopsy. According to the size and the location of lipoma, it may cause intestinal obstruction, perforation, intussusception, and life-threatening bleeding. There have been many reports of small colonic lipomas removed by endoscopic resection. Giant lipoma which is greater than 2 cm in size has been associated with higher risk of perforation, thus it has been removed by surgery until now. We report a case of colonic giant lipoma inducing intussusception which could be removed by endoscopic resection.
Adenomatous Polyps ; Autopsy ; Colon* ; Colonoscopy ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Lipoma* ; Polyps

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome

OBJECTIVE: To compare the clinical outcomes between Day 2 and Day 3 embryo transfer(ET) groups in in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). METHODS: From May, 1997 to December, 1998, 174 cycles of IVF-ET with ICSI were performed and classified into two groups: Day 2 ET group(n=134) and Day 3 ET group (n=40). In Day 3 ET group, embryos fertilized after ICSI were cultured in vitro for further 24 hours in M3 media. RESULTS: There were no significant differences in the age and BMI of patients, basal serum FSH level, protocol of controlled ovarian hyperstimulation(COH), indication of ICSI, and source of sperm for ICSI between two groups. Only the number of the previous failed IVF-ET cycles was significantly higher in Day 3 ET group(p<0.05). Serum E2 level on hCG day, the numbers of oocytes retrieved after COH, oocytes fertilized after ICSI, and embryos transferred, and the rates of fertilization, cleavage, and implantation showed no significant differences. However, cumulative embryo score(CES) was significantly higher in Day 3 ET group(p<0.05). Although there were no significant differences in the rates of pregnancy per ET, spontaneous abortion, and live birth, the rates of biochemical and multiple pregnancy were significantly higher in Day 3 ET group(p<0.05). CONCLUSIONS: In IVF-ET with ICSI, the relatively higher CES may contribute to the higher risk of multiple pregnancy in Day 3 ET group, compared with the conventional Day 2 ET group.
Abortion, Spontaneous ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Humans ; Live Birth ; Oocytes ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Multiple ; Sperm Injections, Intracytoplasmic* ; Spermatozoa

BACKGROUND: Following several decades of decline, the incidence of tuberculosis has recently begun to increase in many countries and the control of this disease has been impeded by the emergence of multi-drug resistant tuberculosis (MDR-TB). The development of rapid diagnostic methods and effective new drugs are needed to control MDR-TB. One of the new drugs for MDR-TB is rifabutin (RBU) which has been known to be effective in some patients with MDR-TB. A few reports showed that some types of mutaitions of the rpoB gene, which were known to be present in 96-98% of rifampicin-resistant M. tuberculosis, were associated with the rifampicin-resistant but RBU-susceptible phenotype. This study was performed to investigate the correlation between RBU susceptibility and the patterns of rpoB gene mutations in Korean MDR-TB. METHODS: Sixty-five clinical isolates of multi-drug resistant Mycobacterium tuberculosis, gathered from patients two visited the Asan Medical Center from July 1997 to June 1999, were investigated. Clinical responses to rifabutin-containing regimen were evaluated. An RBU susceptibility test and sequencing analysis of rpoB gene were performed, and the result were analyzed to confirm which mutations correlated with RBU-susceptible MDR-TB. RESULTS: Fifty-three of 56 (95%) clinical isolates of MDR-TB had 60 mutations of the rpoB gene. The most frequent mutations were found at codon 531 (43%), and two mutations were combined in seven clinical isolates. Five of 53 (10%) clinical isolates showed the RBU-susceptible phenotype, and in them the characteristic patterns of point mutations were found at codon 509, 516, and 526. CONCLUSION: The frequency and pattern of mutations of the rpoB gene of Korean MDR-Tb isolates were similar to those in western countries, where the prevalence of tuberculosis is low, but some show RBU-susceptible phenotypes. RBU-susceptible MDR-TB isolates showed the characteristic pattern of mutations of the rpoB gene which could be used to rapidly diagnose RBU susceptibility.
Chungcheongnam-do ; Codon ; Humans ; Incidence ; Mycobacterium tuberculosis* ; Mycobacterium* ; Phenotype ; Point Mutation ; Prevalence ; Rifabutin* ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

Carcinogens ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 CYP2E1 ; Cytochrome P-450 Enzyme System ; Cytochromes ; DNA Repair ; Exons ; Genes, Suppressor ; Genetic Predisposition to Disease ; Genotype ; Head and Neck Neoplasms ; Head ; Humans ; Metabolism ; Neck ; Negotiating ; Oncogenes ; Polymorphism, Genetic ; Xenobiotics

PURPOSE: There have been high rates of false positive and recall in neonatal screening test using the cut-off points set by the manufacturing company. So, it is necessary to re-evaluate the cut-off values to minimize the false positive rates. METHODS: We collected capillary blood in dry filter paper from 996 healthy neonates on the third day in cases of normal vaginal delivery or the fifth day in cases of Cesarean section. The levels of phenylalanine, galactose, 17-hydroxyprogesterone and branched-chain amino acids were measured using enzyme immunoassay. The results were compared with the original cut-off points set by the manufacturing company. RESULTS: The original cut-off points of four substances were 4.0mg/dL, 7.5mg/dL, 35ng/mL, and 8.0mg/dL, respectively, so that false-positive rates were 0.4, 1.6, 3.93, and 0.001%, respectively. When we set the cut-off point at 99.7 percentile using the data from healthy neonates, they should be 4.0mg/dL, 9.2mg/dL, 54.3ng/mL, and 8.0mg/dL, respectively. CONCLUSION: The false-positive and recall rates were higher in galactosemia and congenital adrenal hyperplasia when using the original cut-off points, suggesting that it would be reasonable to modify the cut-off point at 99.7 percentile after measuring those substances from enough of healthy neonates.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Amino Acids, Branched-Chain ; Capillaries ; Cesarean Section ; Female ; Galactose ; Galactosemias ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Metabolism, Inborn Errors* ; Neonatal Screening* ; Phenylalanine ; Pregnancy

PURPOSE: There have been high rates of false positive and recall in neonatal screening test using the cut-off points set by the manufacturing company. So, it is necessary to re-evaluate the cut-off values to minimize the false positive rates. METHODS: We collected capillary blood in dry filter paper from 996 healthy neonates on the third day in cases of normal vaginal delivery or the fifth day in cases of Cesarean section. The levels of phenylalanine, galactose, 17-hydroxyprogesterone and branched-chain amino acids were measured using enzyme immunoassay. The results were compared with the original cut-off points set by the manufacturing company. RESULTS: The original cut-off points of four substances were 4.0mg/dL, 7.5mg/dL, 35ng/mL, and 8.0mg/dL, respectively, so that false-positive rates were 0.4, 1.6, 3.93, and 0.001%, respectively. When we set the cut-off point at 99.7 percentile using the data from healthy neonates, they should be 4.0mg/dL, 9.2mg/dL, 54.3ng/mL, and 8.0mg/dL, respectively. CONCLUSION: The false-positive and recall rates were higher in galactosemia and congenital adrenal hyperplasia when using the original cut-off points, suggesting that it would be reasonable to modify the cut-off point at 99.7 percentile after measuring those substances from enough of healthy neonates.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Amino Acids, Branched-Chain ; Capillaries ; Cesarean Section ; Female ; Galactose ; Galactosemias ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Metabolism, Inborn Errors* ; Neonatal Screening* ; Phenylalanine ; Pregnancy