Yoo Seob Shin

Radiotherapy Deteriorates Postoperative Functional Outcome After Partial Glossectomy With Free Flap Reconstruction

PURPOSE Most patients with tongue cancer require surgical resection of the tongue to varying degrees. As a result, quality of life, which is strongly related to speech, chewing, and swallowing, can deteriorate severely from extensive surgical treatment of tongue cancer. In addition to surgery, adjuvant therapy may affect the severity of functional impairment. Therefore, the influence of postoperative radiotherapy on functional outcome after partial glossectomy with free flap reconstruction was evaluated in patients with early oral tongue cancer. PATIENTS AND METHODS Functional outcome was measured and charts of 31 patients with oral tongue cancer who were surgically treated at Yonsei Head and Neck Cancer Clinic from 2003 through 2008 were reviewed. Only patients who underwent partial glossectomy and reconstruction with radial forearm free flap and did not develop recurrence were included. Speech integrity was evaluated with diadochokinetic testing by a professional speech therapist. Tongue mobility was checked by measurements of upward distance, protrusion distance, and lateral deviation distance. Swallowing capacity was evaluated with the M.D. Anderson Dysphagia Inventory. RESULTS Diadochokinetic rates of the surgery-only and postoperative radiotherapy groups were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery-only group. Tongue mobility was not statistically different between the 2 groups. CONCLUSIONS Functional outcome of speech and swallowing is negatively influenced by postoperative radiotherapy.

Spontaneous reporting of adverse drug events by Korean regional pharmacovigilance centers

Patterns of prescriptions are markedly influenced by regional disease entities, medical education, culture, economic status, and available pharmaceutical companies. Features of adverse drug reactions (ADRs) may vary in different countries. In this study, we analyzed the causative drugs and clinical manifestations of spontaneously reported ADRs in Korea.

Five cases of food allergy to vegetable worm (Cordyceps sinensis) showing cross-reactivity with silkworm pupae.

Vegetable worm (caterpillar fungus, Cordyceps sinensis) is a traditional medicine in East Asia including China, Korea and Japan. It has recently enjoyed popularity as a food, with health benefits including respiratory-system protection, improved kidney function and enhanced immunity (1, 2). Despite reports of various allergic reactions to silkworm pupae, the hosts of the vegetable worm (3, 4), allergic reactions to vegetable worm are unknown. Here, we report five cases in which allergic symptoms developed following vegetable worm ingestion. The three women and two men had clinical histories of recurrent and immediate-onset allergic symptoms after consuming vegetable worm. All had associated allergic diseases such as respiratory allergy, chronic urticaria and food allergy. Generalized urticaria was the most common symptom. Conjunctivitis, rhinorrhaea, nasal obstruction, cough and dyspnea symptoms were presented in one patient. Symptoms developed 30–120 min after vegetable worm ingestion. All patients had been orally exposed to the suspected allergen, e.g. by drinking tea containing vegetable worm, rather than by skin contact or inhalation. Furthermore, after ingesting silkworm pupae, all experienced allergic symptoms similar to those produced by the vegetable worm (Table 1). Based on their clinical histories, the patients were diagnosed as being allergic to vegetable worm and silkworm pupae. Cross-reactivity between the two was concluded because of antigenic components likely shared during growth of the vegetable worm on silkworm pupae. The patients refused food-challenge testing using the suspected allergens because they had already demonstrated recurrent allergic symptoms after ingesting either one. For immunological studies, vegetable worm and silkworm pupa extracts were prepared in our laboratory as described previously (5), and skin prick tests that was performed using them showed positive responses. Serumspecific IgE antibodies to both extracts were detected by enzyme-linked immunosorbent assay (ELISA). The positive cut-off value for high level of serum-specific IgE antibody was defined as the mean ± 3 standard deviation of the absorbance value from 32 nonatopic healthy controls. Accordingly, four of the five patients showed high levels of a serum-specific IgE to vegetable worm and silkworm pupa extracts (Fig. 1A). Competitive ELISA inhibition tests to evaluate cross-reactivity between the vegetable worm and silkworm pupae showed significant dose-dependent inhibitions in response to either antigen Vegetable worm can induce food allergy, which is mediated by both IgE and non-IgE mechanisms, and cross react with silkworm pupae. ALLERGY Net

Optimal conditions for the removal of house dust mite, dog dander, and pollen allergens using mechanical laundry

BACKGROUND Mechanical laundry is an effective tool for the environmental control of allergens, but the optimal conditions for removing allergens are not yet clear. OBJECTIVE To evaluate the optimal conditions of mechanical laundry for the removal of house dust mite (HDM), dog dander, and pollen allergens. METHODS The 4 washing modes of 30 degrees C (86 degrees F), 40 degrees C (104 degrees F), 60 degrees C (140 degrees F), and steam water (SW) with detergent were evaluated. Allergen removal performance was assayed using a 2-site enzyme-linked immunosorbent assay (ELISA) or an ELISA inhibition test. RESULTS Using the 30 degrees C and 40 degrees C washing modes, only 6.5% and 9.6% of Dermatophagoides farinae, respectively, were killed. However, using the 60 degrees C and SW washing modes, all HDMs were killed. The amounts of Der f 1 remaining after the 30 degrees C, 40 degrees C, 60 degrees C, and SW washing modes were 26.8%, 2.4%, 1.3%, and 0.6%, respectively, with unmanipulated contaminated sheets. The effects of rinse on Der f 1 levels after the 30 degrees C washing were greater compared with those after the 40 degrees C, 60 degrees C, and SW modes. The amounts of Can f 1 in the extractions after washing were 0.3% to 1.3% for all modes, and all extracts, even without a rinse, did not inhibit specific IgE binding to dog allergens according to ELISA. The remaining pollen allergen levels after washing were lower in the 60 degrees C and SW modes than in the lower temperature modes. However, the levels did not differ among the various washing modes after rinsing once. CONCLUSION Water temperature and number of rinses are critical factors for the removal of HDM, dog dander, and pollen allergens.

Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results

Purpose To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. Materials and Methods The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. Results In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). Conclusion ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

Endoscopic removal of a cystic neck mass via an axillo‐breast approach

INTRODUCTION Benign cystic neck masses can be found in any portion of the neck area, especially in the young age group. Benign cystic neck masses such as branchial cleft cyst, epidermal cyst, and lymphangioma are commonly found beneath the sternocleidomastoid (SCM) muscle, perithyroidal area. The treatment of choice for these benign cystic neck lesions is surgical excision. Conventional excision is performed through an incision placed over the entire protruding area. This approach produces an incision on the neck, resulting in a final scar that is evident and aesthetically undesirable. By means of an alternative approach, several authors previously reported the surgical excision of cervical branchiogenic cysts via transcervical endoscopic approach. However, even though the scar is small, these techniques still leave a visible one on the neck. Considering that one of the most important goals of endoscopic surgery is to minimize a visible scar in a natural position, incisions on the body part that is easily seen should be avoided. In recent years, we have been performing endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for the purpose of minimizing the visible scar in a natural position, and we have already reported the feasibility and safety in thyroid surgery. At this point, we applied this approach to benign cystic neck lesions, and we herein report our successful outcomes.

Food allergy to meat and milk in adults

with a clinical diagnosis of ‘happy wheezers’. One child was atopic. Structural airway anomalies were found in 15 patients (44%). The final diagnosis was primary tracheoor broncho-malacia in 14 patients (42%): five had tracheomalacia alone (Fig. 1), four bronchomalacia alone, and five had TBM. Tracheomalacia was localized in the middle third (60%) and lower third (40%) of the trachea. One patient had laryngomalacia unassociated with any TBM. It is worth noting that a bronchoscopic diagnosis of TBM was reached in 9/12 (75%) of the children diagnosed as ‘happy wheezers’. Our study shows that recurrent/persistent wheezing failing to respond to conventional asthma therapy in children <3 years of age is often associated with TBM (42% of cases in our series), according with previous reports in children (2–5). The novelty of our study lies in that we investigated a subset of infants labeled as ‘happy wheezers’ – and 75% of them revealed TBM at bronchoscopy. TBM is a weakness of the trachea and mainstem bronchi such that the airway is more susceptible to collapse during expiration (Fig. 1), causing airflow limitation and wheezing that may mimic asthma (5). Mild–moderate airway malacia is a self-limiting disease, and most infants grow out of the condition by the time they are 2–3 years old (4, 5). A recent report estimated the incidence of primary airway malacia to be at least 1/ 2100 children (4), supporting the conviction that TBM is underdiagnosed. In accordance with previous studies, we believe that FB is a safe and useful tool for achieving a definitive diagnosis and preventing any inappropriate asthma treatment (1, 4). Limits of our study are that the results cannot be generalized to all wheezing young children, because we studied a highly selected group, and that we cannot rule out the possibility of TBM and asthma coexisting in the same child. In conclusion, this study suggests that TBM is quite a common airway anomaly in children with recurrent/ persistent wheezing failing to respond to conventional asthma therapy. We also suggest that many infants diagnosed as ‘happy wheezers’ may, in fact, have underlying tracheobronchomalacia.

Current status of oriental medicine in treating Korean allergy patients

To evaluate the prevalence, compliance, pattern of use, and economic cost of OM in Korean allergy patients.

Endotoxin Is Not Essential for the Development of Cockroach Induced Allergic Airway Inflammation

Purpose Cockroach (CR) is an important inhalant allergen and can induce allergic asthma. However, the mechanism by which CR induces airway allergic inflammation and the role of endotoxin in CR extract are not clearly understood in regards to the development of airway inflammation. In this study, we evaluated whether endotoxin is essential to the development of CR induced airway allergic inflammation in mice. Materials and Methods Airway allergic inflammation was induced by intranasal administration of either CR extract, CR with additional endotoxin, or endotoxin depleted CR extract, respectively, in BALB/c wild type mice. CR induced inflammation was also evaluated with toll like receptor-4 (TLR-4) mutant (C3H/HeJ) and wild type (C3H/HeN) mice. Results Intranasal administration of CR extracts significantly induced airway hyperresponsiveness (AHR), eosinophilic and neutrophilic airway inflammation, as well as goblet cell hyperplasia in a dose-dependent manner. The addition of endotoxin along with CR allergen attenuated eosinophilic inflammation, interleukin (IL)-13 level, and goblet cell hyperplasia of respiratory epithelium; however, it did not affect the development of AHR. Endotoxin depletion in CR extract did not attenuate eosinophilic inflammation and lymphocytosis in BAL fluid, AHR and IL-13 expression in the lungs compared to CR alone. The attenuation of AHR, eosinophilic inflammation, and goblet cell hyperplasia induced by CR extract alone was not different between TLR-4 mutant and the wild type mice. In addition, heat inactivated CR extract administration induced attenuated AHR and eosinophilic inflammation. Conclusion Endotoxin in CR extracts may not be essential to the development of airway inflammation.

Necessity of level IV dissection in cN0 hypopharyngeal carcinoma

Abstract Conclusions: We suggest that contralateral level IV dissection is not necessary in patients with cN0 hypopharyngeal squamous cell carcinoma (HPSCC). Objectives: Elective treatment of neck nodes is very important in the management of cN0 HPSCC. A selective neck dissection neck level II to IV (SND II–IV) is widely accepted as an elective neck treatment of cN0 HPSCC. However, there has been a lot of effort to reduce the extent of surgery. Therefore, we investigated the incidence of level IV metastasis and regional recurrence in cN0 HPSCC. Methods: We performed a retrospective review of 40 patients who underwent SND II–IV as an elective treatment for cN0 HPSCC from 1992 to 2010. Results: In all, 30 bilateral and 10 unilateral SND II–IVs were performed in 40 patients. Of the 70 SND II–IV specimens, 15 specimens from 14 patients (21%) were revealed to have positive lymph node metastasis. Level IV was involved in 3 of 70 necks (4.2%), but no isolated or contralateral level IV metastasis was observed. Every case that had level IV metastasis also had positive nodes in level II or III. There was no case of postoperative chylous leakage and only one case of phrenic nerve palsy.