Byun, Sung Wan;Kim, Han Wool;Yoon, Seo Hee;Park, In Ho;Kim, Kyung-Hyo
Pediatric Infection and Vaccine
/
v.22
no.2
/
pp.106-112
/
2015
Purpose: The long-term administration of antibiotics interferes with bacterial culture in the middle ear fluids (MEFs) of young children with otitis media with effusion (OME). The purpose of this study is to determine whether molecular diagnostics can be used for rapid and direct detection of the bacterial pathogen in culture-negative MEFs. Methods: The specificity and sensitivity of both polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) to the lytA gene of Streptococcus pneumoniae were comparatively tested and then applied for pneumococcal detection in the clinical MEFs. Results: The detection limit of the PCR assay was approximately $10^4$ colony forming units (CFU), whereas that of LAMP was less than 10 CFU for the detection of S. pneumoniae. Both PCR and LAMP did not amplify nucleic acid at over $10^6$ CFU of H. influenzae or M. catarrhalis, both of which were irrelevant bacterial species. Of 22 culture-negative MEFs from children with OME, LAMP positivity was found in twelve MEFs (54.5%, 12/22), only three of which were PCR-positive (25%, 3/12). Our results showed that the ability of LAMP to detect pneumococcal DNA is over four times higher than that of PCR (P<0.01). Conclusions: As a high-resolution tool able to detect nucleic acid levels equivalent to <10 CFU of S. pneumoniae in MEFs without any cross-reaction with other pathogens, lytA -specific LAMP may be applied for diagnosing pneumococcus infection in OME as well as evaluating the impact of a pneumococcal conjugate vaccine against OME.
Seo, Hyun-Joo;Lee, Jae Suk;Shin, Hong-Beom;Kim, Eui-Joong;Shim, Hyun-Joon;Ahn, Young-Min
Clinical and Experimental Pediatrics
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v.51
no.3
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pp.267-275
/
2008
Purpose : To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. Methods : 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). Results : There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS ($9.4{\pm}4.6\;vs\;10.8{\pm}4.5$), and OSA-18 score ($61.1{\pm}25.1\;vs\;71.2{\pm}8.4$). The patients with OSAS ($15.8{\pm}7.9$) and PS ($22.2{\pm}9.4$) had a higher ADHD RS-IV score than the control subjects ($2.9{\pm}3.3$). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. Conclusion : We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.
Purpose : Ciliary abnormalities of the respiratory system usually accompany recurrent or persistent respiratory diseases such as paranasal sinusitis, bronchiectasis, rhinitis, and/or otitis media, since they cause certain derangements in ciliary cleaning activities. This disease is usually inherited by autosomal recessive trait, but may also be found to be acquired or transient in rare cases after heavy exposure to pollutants, cigarette smoking or severe infection. We performed this study in children with frequently recurrent or persistent respiratory diseases to clarify if the ciliary abnormalities are preceding factors. Methods : We enrolled 17 children with suspected respiratory ciliary abnormalities. The indications for evaluation of ciliary ultrastructure were recurrent or persistent respiratory infections. Children with immunologic abnormalities were excluded. From August 2000 to July 2003, we performed a biopsy on nasal mucosa and examined the structure of ciliary status by using an electron microscope. Results : Of the subjects, there were seven males and 10 females, aged 2 to 10 years. Out of the 17 subjects, 12 cases of chronic paranasal sinusitis, nine chronic coughs, nine frequent upper respiratory infections, seven cases of recurrent otitis media, four cases of recurrent pneumonia, and four cases of bronchial asthma were found. Out of the 17 cases on which histologic examinations were conducted, four cases showed pathologic findings, including one case of inner dynein arm defect, one of microtubular transposition, one of supernumerous tubules, and one singlet, respectively. Conclusion : It is essential for differential diagnosis and effective treatment to identify the abnormalities of ultrastructure of nasal cilia in children with symptoms of frequently recurrent or persistent respiratory diseases, if immunodeficiency or respiratory allergy could be excluded.
Interleukin 27 (IL-27) was discovered as a heterodimeric cytokine of the IL-12 family, and is composed of two subunits - Epstein-Barr virus induced gene 3 (EBI3) and p28. It acts as a versatile cytokine in the early regulation of Th1 initiation and in the negative regulation of the Th2 factor GATA binding protein 3 (GATA-3). This cytokine is mediated by the IL-27 receptor (WSX-1), which is highly expressed on $CD4^+$ T lymphocytes and NK cells. We previously identified four polymorphisms in the human IL-27p28 gene and suggested that the polymorphism of IL-27p28 is associated with susceptibility to asthma. To determine whether these IL-27p28 SNPs are associated with susceptibility to allergic rhinitis, the genotype and allele frequencies of IL-27p28 SNPs were analyzed between allergic rhinitis patients and healthy controls. Although the genotype and allele frequencies of IL-27p28 SNPs in allergic rhinitis patients were not significantly different from those of the control group, there was a suggestive difference (P=0.037) between these groups in total serum IgE levels in the g.2905T>G SNP of the IL-27p28 gene. Our result implies that the g.2905T>G SNP of the IL-27p28 gene might have an affect on IgE production in allergic rhinitis patients.
Background: The aim of this study was to investigate whether family history of cancer is associated with head and neck cancer risk in a Chinese population. Materials and Methods: This case-control study included 921 cases and 806 controls. Recruitment was from December 2010 to January 2015 in eight centers in East Asia. Controls were matched to cases with reference to sex, 5-year age group, ethnicity, and residence area at each of the centers. Results: We observed an increased risk of head and neck cancer due to first degree family history of head and neck cancer, but after adjustment for tobacco smoking, alcohol drinking and betel quid chewing the association was no longer apparent. The adjusted OR were 1.10 (95% CI=0.80-1.50) for family history of tobacco-related cancer and 0.96 (95%CI=0.75-1.24) for family history of any cancer with adjustment for tobacco, betel quid and alcohol habits. The ORs for having a first-degree relative with HNC were higher in all tobacco/alcohol subgroups. Conclusions: We did not observe a strong association between family history of head and neck cancer and head and neck cancer risk after taking into account lifestyle factors. Our study suggests that an increased risk due to family history of head and neck cancer may be due to shared risk factors. Further studies may be needed to assess the lifestyle factors of the relatives.
In 1965, Rosenberg reported that platinum compounds not only inhibit growth and cell division of E. coli but also has anti-tumor activity. Since then, through animal and clinical experiments by Welsch(1971), Speer(1972), Rossof(1972), Hill(1974), and Wittes(1975), it was proved that Cis-platinum has excellent supressive effects on malignant tumor, especially on head and neck cancer. Accordingly, Cis-platinum is now widely used, sometimes without any other durg, or sometimes with Bleomycin and Methotrexate etc. Inspite of the strong anticancer effect, the use of Cis-platinum is quite often discouraged because of the reports that Cis-platinum causes auditory impairment at high frequencies above the speech range due to inner ear damage and irreversible change in the renal tubules. Since Kohonen et al(1965), Standnicki et al(1974) reported that Cisplatinum has toxic effects at the basal turn of the cochlea using guinea pig, many studies on ototoxicity after infusion of Cis-platinum have been carried out using animals. But the studies on ototoxicity in human beings can hardly be found except in reports by Piel et al(1974) and Hong et al (1979). So the authors did a study which tried to clarify the ototoxic effect by comparing the hearing level after infusion of Cis-plastinum with the hearing level before infusion of Cis-plastinum in 30 patients who was treated with Cis-platinum and admitted to the dept. of otolaryngology of Yonsei University Hospital during 2 years and a half from July. 1979 to March. 1982 and the following results were obtained. 1) The results of auditory evaluation, using the pure tone average, hearing loss of 4kHz and 8kHz, Speech Reception Threshold, PB score, SISI showed that the difference of dosage does not change the hearing level after infusion of Cis-platinum and before infusion of Cis-platinum. 2) Cis-platinum had no effect on the hearing level of patients with conductive hearing loss, or with sensorineural hearing loss, as well as with normal hearing level. 3) The infusion of Cis-platinum did not cause any change in creatinine clearance, creatinine, uric acid, but only one case showed that Cis-platinum caused severe nephrotoxicity. 4) The infusion of Cis-plastinum did not cause any change in hemoglobin, leukocyte count, platelet count and there was no correlation with the amount of infusion. 5) To see the side effect of hydration practiced with the infusion of Cis-platinum, the electrolytes, particularly the K level in the serum was measured. But the results did not show any change. 6) Judging from the results of this study mentioned above, ototoxicity caused by infusion of Cis-platinum can be prevented by sufficient hydration. Also the results might say that the appropriate method of infusion of Cis-platinum might be effective in the patients with head and neck cancer who had sensorineural hearing loss for whom the infusion of Cis-platinum has been absolutely cotraindicated.
Papilloma is the common benign tumor of the larynx and the incidence of its malignant change was variable. The authors recently experienced 2 cases of squamous cell carcinoma of the larynx which were considered to be transformed from laryngeal papilloma. Case 1. A 58 year old male patient visited O.P.D. of Department of Otolaryngology of Busan National University Hospital, because of hoarseness for 3 years on May 13th, 1980. At that time, local finding of indirect laryngoscopy revealed whitish hypertrophic papillomatous mass on both vocal cords and anterior commissure, and dirty gray white pseudomembrane on left aryepiglottic fold, and the result of biopsy was squamous cell papilloma. So the laryngeal papilloma was removed under suspension laryngoscopy and then he had no specific treatment in spite of being recommended 5-FU topical spray. On March 5th, 1981, he visited O.P.D. again because of progressive exacerbation of hoarseness with mild dyspnea and histopathological finding was revealed squamous cell carcinoma of the larynx. Seven days later from that day, he visited emergency room due to severe dyspnea, and emergency tracheostomy was performed on sitting position. On April 7th 1981, total laryngectomy was performed successfully and postoperative irradiation therapy was recommended. Case 2. A 47 year old male patient visited our O.P.D. because of hoarseness for 5 years on Sep. 27, 1978. At that time, local finding of indirect laryngoscopy revealed papillomatous mass on left vocal cord and left ventricle and result of biopsy was squamous cell papilloma. So he had been treated with 11 times removal of papilloma, topical spray of 5-Fu and estrogen for 3 years, but the papilloma had been recurred. On Sep. 9th, 1981, he visited O.P.D. because of severe dyspnea and emergency tracheostomy and biopsy was performed. The result of biopsy was squamous cell carcinoma of larynx and total laryngectomy was performed successfully.
The major advancement in phonosurgery due to recent development of laryngomicrosurgery enabled more accurate diagnosis and treatment of patient with voice disorders. Among large proportion of voice disordered patients, prominent linear furrow running parallel along the free edge of vocal cord extending from the vocal process to anterior commissure can be seen as well as incomplete closure during phonation. These cases were illustrated and coined as sulcus vocalis by Salvi in 1901, since then other similar paper was reported in Europe and Japan, but has not been reported in Korea. The exact etiology and therapeutic methods of sulcus vocalis has not been elaborated. At Department of Otolaryngology of Yonsei University College of Medicine a series of voice analysis were performed among those 35 patients with sulcus vocalis visited to Vocal Dynamics Laboratory from May, 1981 to March, 1982. Following is the result of clinical statistical investgation and therapeutic modality. 1) The incidance of sulcus vocalis among 290 patients with voice disorder visited to Vocal Dynamics Laboratory was approximately 12%(35 cases). 2) Onset of this voice disorder was most frequent among patient under 10 year-old groups; 19 cases (54%) followed by second decade, third decade groups in decreasing frequency respectably. 3) The etiology of sulcus vocalis was mostly unknown. The sequelae after measle (4 cases) and severe upper respiratory infection (3 cases) and congenital deformity (2 cases) were the possible causes of sulcus vocalis. 4) These patients were involved bilaterally in 25 cases (71%), left side only in 8 cases (23%) and right side only in 2 cases (6%). 5) Almost all patients complained hoarseness and 7 patients were suffering from chronic laryngitis. 6) In aerodynamic analysis, Maximal Phonation Time was decreased in 20 cases (57%), Phonation Quotient was increased in 22 cases (63%) and Mean Air Flow Rate was increased in 23 cases (66%). 7) Among them, 33 cases were analyzed with stroboscopy. The findings were as follows; incomplete glottic closure during phonation in 31 cases (93%), regular vocal cord movement in whole cases, asymmetric cord movement in 4 cases (12%), decreased amplitude in 5 cases (21%) and small mucosal wave in 24 cases (73%). 8) Intracordal Teflon injection in 5 cases and Sulcusectomy in 1 cases were performed as therapeutic management, however, the therapeutic results were not effective except one case with Teflon injection.
Purpose: Accurate evaluation of cervical lymph node (LN) metastasis of head and neck squamous cell canter (SCC) is important to treatment planning. We evaluated the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of cervical LN metastasis of head and neck SCC and performed a retrospective comparison with CT/MRI findings. Materials & Methods: Seventeen patients with pathologically proven head and neck SCC underwent F-18 FDG PET/CT and CT/MRI within 4 week before surgery. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. F-18 FDG PET/CT images were analyzed visually for assessment of regional tracer uptake in LN. We analyzed the differences in sensitivity and specificity between F-18 FDG PET/CT and CT/MRI using the Chi-square test. Results: Among the 17 patients, a total of 123 LN levels were dissected, 29 of which showed metastatic involvement. The sensitivity and specificity of F-18 FDG PET/CT for detecting cervical LN metastasis on a level-by-level basis were 69% (20/29) and 99% (93/94). The sensitivity and specificity of CT/MRI were 62% (18/29) and 96% (90/94). There was no significant difference in diagnostic accuracy between F-18 FDG PET/CT and CT/MRI. Interestingly, F-18 FDG PET/CT detected double primary tumor (hepatocellular carcinoma) and rib metastasis, respectively. Conclusion: There was not statistically significant difference of diagnostic accuracy between F-18 FDG PET/CT and CT/MRI for the detection of cervical LN metastasis of head and neck SCC. The low sensitivity of F-18 FDG PET/CT was due to limited resolution for small metastatic deposits.
Purpose : The objective of this study was to clarify the presentation, associated preceding illness, pathologic organisms, treatment and outcome of deep neck abscess in children according to age and location. Methods : We retrospectively reviewed the in-patient charts of children treated at our hospital for deep neck abscess. Thirty-five such patients were identified as having been treated from March 1990 to December 2005. Results : A total of 35 were enrolled in our study: 25 boys and 10 girls. Their ages ranged from 11 months to 15 years. Presenting symptoms included mass, fever, irritability, trismus and dysphagia. The most commonly known associated preceding illness was viral upper respiratory infection (53%). The most common site of infection was the submandibular space (37%). Bacteria was identified in 16 patients. The most common pathogen was Staphylococcus aureus. Thirteen (37%) children recovered from the infection with conservative treatment and twenty-four (68%) children received surgical drainage. The duration of hospitalization was longer in the group who underwent surgery than in the group who were managed with conservative treatment. No complication occurred. Conclusion : Unexplained torticollis, trismus or irritability in children were suggestive of deep neck abscess. Our results demonstrate that deep neck abscesses in children is respond well to conservative treatment if diagnosed early.
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