Hyun Chang

Early Compliance and Efficacy of Sublingual Immunotherapy in Patients with Allergic Rhinitis for House Dust Mites

Objectives Sublingual immunotherapy (SLIT) has recently received much attention around the world as a treatment for allergic rhinitis. This study aimed to investigate the efficacy and adverse effects of SLIT in Korean patients with allergic rhinitis caused by house dust mites. The treatment compliance and the patient satisfaction with SLIT were also assessed. Methods The patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who started SLIT between November 2007 and July 2008 were included in this study. The symptom questionnaires, which included items on rhinorrhea, sneezing, nasal obstruction, itchy nose, olfactory disturbance, eye discomfort and sleep disturbance, were obtained before and 6 months after SLIT. The patient satisfaction and the adverse effects were also investigated. Results One hundred forty-two patients started SLIT and 98 of them continued SLIT for 6 months or more. Ninety-two of the 98 patients completed the questionnaires. The duration of receiving SLIT was 9.8 months on average (range, 6 to 13 months). All the symptoms of allergic rhinitis were improved with SLIT. Forty-five percent of the patients were satisfied for SLIT, while 12% were unsatisfied. The incidence of adverse effects was 12% during maintenance therapy, although it was 48% during the up-dosing phase. The drop-out rate of SLIT was 31.0%. Conclusion The subjective symptoms were improved with SLIT in Korean patients with allergic rhinitis for house dust mites. Yet the drop out rate was high despite of the symptomatic improvement.

Primary Tracheal Tumors: Review of 37 Cases

Introduction: Primary tracheal tumors are rare, and composed of various benign and malignant pathologies. Although nationwide epidemiologic studies were reported in western population, study about the oriental population is lacking. The aims of this study were to establish the clinical manifestations and treatment outcomes of primary tracheal tumors and explore the prognostic variables for malignant tracheal tumors. Methods: From January 1989 through December 2006, 37 patients (14 with benign tumors, 23 with malignant tumors) were treated in a tertiary referral center. Retrospective review of medical records was performed. Results: Benign tumors comprised of various pathologies. Except the papilloma cases (n = 3), all of them were managed successfully without recurrence. Squamous cell carcinomas (n = 11) and adenoid cystic carcinomas (n = 9) comprised most of the malignant tumors. Clinical stage was a statistically significant prognostic variable (p = 0.016). Five-year overall survival rate was 41.1% for squamous cell carcinoma and 45.7% for adenoid cystic carcinoma and no statistically significant difference (p = 0.673) was observed. Conclusion: Papillomas were difficult to manage, however, other benign tumors were successfully treated. Among malignant tumors, surgery should be considered as the first choice of treatment, regardless of the histologic type, if the tumors are resectable.

Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients.

Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB–IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67xa0%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, and 79 (84xa0%) had non-small-cell lung cancer. In total, 28 patients (30xa0%) were newly diagnosed or were receiving first-line treatment, and 22 (23xa0%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90xa0%), and ICU mortality and hospital mortality were 57 and 78xa0%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratio <150 [odds ratio (OR)xa0=xa05.51, 95xa0% confidence interval (CI) 2.10–14.48, pxa0=xa00.001] was independently associated with ICU mortality, and an ECOG PS ≥2 (ORxa0=xa09.53, 95xa0% CI 2.03–44.85, pxa0=xa00.004) and a need for vasoactive agents (ORxa0=xa06.94, 95xa0% CI 1.61–29.84, pxa0=xa00.009) were independently associated with hospital mortality. Refractory or bedridden patients (nxa0=xa022) showed significantly poorer overall survival (11.0 vs. 29.0xa0days, pxa0=xa00.005). Among 21 patients who were discharged from the hospital, 11 (52xa0%) received further chemotherapy. Certain advanced lung cancer patients may benefit from ICU management. However, refractory patients and patients with a poor PS do not seem to benefit from ICU care. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

The early discontinuation of palliative chemotherapy in older patients with cancer

PurposeOlder patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.MethodsNinety-eight patients older than 65xa0years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson’s co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.ResultsActive treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1xa0months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OSu2009=u20093.1 vs. 14.7xa0months in patients with ED compared with patients without ED, pu2009<u20090.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (pu2009=u20090.001, pu2009=u20090.048, pu2009=u20090.001, pu2009<u20090.001, pu2009<u20090.001, pu2009=u20090.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratiou2009=u20095.03; 95xa0% confidence intervalu2009=u20091.50–16.87: odds ratiou2009=u20093.06; confidence intervalu2009=u20091.03–9.12, respectively).ConclusionsED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.

Fat deposition in the tunica muscularis and decrease of interstitial cells of Cajal and nNOS-positive neuronal cells in the aged rat colon

Little is known about the time course of aging on interstitial cells of Cajal (ICC) of colon. The aim of this study was to investigate the change of morphology, ICC, and neuronal nitric oxide synthase (nNOS)-immunoreactive cells in the aged rat. The proximal colon of 344 Fischer rats at four different ages (6, 31, 74 wk, and 2 yr) were studied. The immunoreactivity of c-Kit, nNOS, anti-protein gene product 9.5, and synaptophysin were counted after immunohistochemistry. The c-kit, stem cell factor (ligand of Kit), and nNOS mRNA were measured by real-time PCR. c-Kit and nNOS protein were assessed by Western blot. Isovolumetric contractile force measurement and electrical field stimulation (EFS) were conducted. The area of intramuscular fat deposition significantly increased with age after 31 wk. c-Kit-immunoreactive ICC and nNOS-immunoreactive neurons and nerve fibers significantly declined with age. mRNA and protein expression of c-kit and nNOS decreased with aging. The functional study showed that the spontaneous contractility was decreased in aged rat, whereas EFS responses in the presence of atropine and L-NG-Nitroarginine methyl ester were increased in aged rat. In conclusion, the decrease of proportion of proper smooth muscle, the density of ICC and nNOS-immunoreactive neuronal fibers, and the number of nNOS-immunoreactive neurons during the aging process may explain the aging-associated colonic dysmotility.

Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid chemocauterization : A preliminary report

PURPOSEnOpen repair with a second thoracotomy is technically challenging and has a high risk of complications for the treatment of a recurrent tracheoesophageal fistula (RTEF). Therefore, less invasive endoscopic techniques have been developed. Here, we report on the chemocauterization with trichloroacetic acid (TCA) technique for endoscopic management of RTEF.nnnMETHODSnThree patients who had an open repair with thoracotomy for congenital tracheoesophageal fistula and were diagnosed with RTEF were included in this study. Rigid ventilating bronchoscopy with telescopic magnification was used to evaluate and manage the RTEF. After identification of the fistula opening, a 50% TCA-soaked small cotton ball was applied in the opening 3 times during each session.nnnRESULTSnThe mean number of procedures was 3.3, and the fistulae were closed in all cases. Closure of the fistula was confirmed by esophagogram and/or bronchoscopy. There were no postoperative complications.nnnCONCLUSIONnThe results of this study showed that chemocauterization with TCA can be safe and effective for the management of RTEF.

Novel experimental rabbit model of anterior glottic web formation.

Abstract Conclusion: The rabbit model of anterior glottic web (AGW) formation using the laryngofissure technique resulted in reproducible and stable AGW formation that may facilitate research into this area. Objective: To introduce and validate a novel experimental animal model of AGW formation using the rabbit. Methods: The inner larynges of eight New Zealand white rabbits were exposed through the laryngofissure technique. The mucosa of the bilateral true vocal fold was stripped off using the bevel of a needle tip. On the basis of the laryngoscopic findings at 8 weeks postoperatively, the extent of AGW was measured, and the success of this procedure was validated. Laryngeal specimens were sampled at 8 weeks for high-speed recording and histological analysis. Results: In seven (87.5%) rabbits, laryngoscopic examination revealed the formation of a scar band involving the anterior commissure. The mean extent of AGW ratio on the left and right sides was 0.58 ± 0.073 and 0.55 ± 0.075, respectively. The symmetric formation of AGW (p = 0.655, p = 0.128) and stability of the AGW procedure (p = 0.491, left; p = 0.501, right) were statistically validated. On high-speed recording, the vocal mucosal wave was hindered by AGW formation. Histologically, fibro-connective tissue, especially collagen fiber, was observed in the anterior commissure.

Gastric choristoma of the oropharynx.

Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.

Maxillectomy Reconstruction with Various Flaps: Preliminary Results and Suggested Algorithm

Objectives: Although maxillary reconstruction after maxillectomy for the malignant tumor is still controversial, various reconstruction techniques have been introduced. Since reconstruction methods could be varied by the defects and surgeon’s preference, we would like to share our reconstruction algorithm and show preliminary results. Methods: Thirteen cases of maxillectomy reconstruction during the past 18 months were reviewed. The types of defects, reconstruction methods, and outcomes were reviewed. The types of defects after maxillectomy were as various as Brown class IIa, IIb, IIIb, IIId, IVb, IVd, and V. Reconstructions were performed using free flaps from the iliac crest, radial forearm, rectus abdominis, and latissimus dorsi. When the maxillectomy included orbital exentration, soft tissue free flaps for defects were preferred. On the other hand, defects for bony lesions including alveolar ridge and orbital rim were reconstructed with iliac crest osteomuscular (or osteomusculocutaneous) free flap. Results: All of them were well reconstructed without any complication. The content, especially the orbital content and bony structure, and size of the maxillectomy defect, tumor characteristics, and patients’ prognosis should be considered in the selection of maxillectomy reconstruction. Conclusions: The iliac crest free flap might be one of the best options to reconstruct the bony defect after maxillectomy.