Development of enterohepatic fistula after embolization in ileal gastrointestinal stromal tumor: A case report

Gastrointestinal stromal tumor(GIST)is a rare mesenchymal tumor of the gastrointestinal tract that has been associated with the formation of fistulas to adjacent organs in few case reports.However,GIST with enterohepatic fistula has not been reported.Here we report the case of an enterohepatic fistula that occurred after embolization of a liver mass originating in the distal ileum.An 87-year-old woman was hospitalized for melena.On initial conventional endoscopy,a bleeding focus in the gastrointestinal tract was not found.Because of massive hematochezia,enteroscopy was performed through the anus.A protruding,ulcerative mass was found in the distal ileum that was suspected to be the source of the bleeding;a biopsy sample was taken.Electrocoagulation was not successful in controlling the bleeding;therefore,embolization was performed.After embolization,the patient developed a high fever and severe abdominal tenderness with rebound tenderness.Follow-up abdominopelvic computed tomography revealed an enterohepatic fistula between the liver and distal ileum.The fistula was treated surgically by segmental resection of the distal ileum and unlooping of the liver mass.     

Eyelid mass secondary to injection of calcium hydroxylapatite facial filler

A 37-year-old woman presented with a 2-month history of fullness and ptosis of the left upper eyelid. Examination revealed a 6-cm x 2-cm mass in the left brow and upper eyelid, and a diffuse mass in the lower eyelid. Marked ptosis of the left upper eyelid and elevation of the left lower eyelid were noted. CT showed masses with a bone-like density in the left eyelid and periorbital soft tissue. A through history revealed that the patient had received calcium hydroxylapatite filler injection for nose augmentation 3 days prior to the development of the eyelid masses. The eyelid masses were excised and pathologically confirmed as calcium hydroxylapatite microspherules surrounded by collagen and histiocytes. Two months after surgery, the eyelid masses and ptosis of the left upper eyelid were completely resolved. To our knowledge, this is the first reported case of eyelid mass after injection of calcium hydroxylapatite facial filler for nose augmentation.     

A new osteotomy for the correction of mandibular prognathism: techniques and rationale of the intraoral vertico-sagittal ramus osteotomy.

The sagittal split ramus osteotomy (SSRO) and the intraoral vertical ramus osteotomy (IVRO) are long established methods for correcting mandibular prognathism, each having its own advantages. However, both procedures have the same disadvantage: the potential for postoperative condylar displacement. The displacement of the condyle is mainly due to the fact that the osteotomy plane is not parallel to the original sagittal plane in which the mandible is repositioned. The author has developed a new ramus osteotomy since 1985 in which the osteotomy plane is theoretically parallel to the original sagittal plane and thereby attempting to decrease the incidence of condylar displacement. This osteotomy was designed additionally to decrease neurosensory disturbances and has the advantages of both methods, and therefore has been named 'intraoral vertico-sagittal ramus osteotomy (IVSRO)'. Initial experience with the 24 prognathic patients operated on by means of the IVSRO indicated excellent clinical results. It has been noted clinically that the IVSRO is very effective in reducing postoperative iatrogenic TMJ symptoms and in treating preoperative TMJ symptoms. It has the additional effect of reducing neurosensory disturbances. This osteotomy seems to be more applicable in mandibular prognathism with excessive flaring of the ramus, particularly that associated with TMJ dysfunction, because the IVSRO has a 'condylotomy effect' and its splitting plane diverges less from the original sagittal plane than that of the SSRO and the IVRO.     

Management for the Children with Otitis Media with Effusion in the Tertiary Hospital

Objectives

Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study.

Methods

Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months.

Results

Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05).

Conclusion

In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.     

Lithospermum erythrorhizon Alleviates Atopic Dermatitis-like Skin Lesions by Restoring Immune Balance and Skin Barrier Function in 2.4-Dinitrochlorobenzene-Induced NC/Nga Mice

The incidence of atopic dermatitis (AD), a disease characterized by an abnormal immune balance and skin barrier function, has increased rapidly in developed countries. This study investigated the anti-atopic effect of Lithospermum erythrorhizon (LE) using NC/Nga mice induced by 2,4-dinitrochlorobenzene. LE reduced AD clinical symptoms, including inflammatory cell infiltration, epidermal thickness, ear thickness, and scratching behavior, in the mice. Additionally, LE reduced serum IgE and histamine levels, and restored the T helper (Th) 1/Th2 immune balance through regulation of the IgG1/IgG2a ratio. LE also reduced the levels of AD-related cytokines and chemokines, including interleukin (IL)-1β, IL-4, IL-6, tumor necrosis factor-α (TNF-α), thymic stromal lymphopoietin, thymus and activation-regulated chemokine, macrophage-derived chemokine, regulated on activation, normal T cell expressed and secreted, and monocyte chemoattractant protein-1 in the serum. Moreover, LE modulated AD-related cytokines and chemokines expressed and secreted by Th1, Th2, Th17, and Th22 cells in the dorsal skin and splenocytes. Furthermore, LE restored skin barrier function by increasing pro-filaggrin gene expression and levels of skin barrier-related proteins filaggrin, involucrin, loricrin, occludin, and zonula occludens-1. These results suggest that LE is a potential therapeutic agent that can alleviate AD by modulating Th1/Th2 immune balance and restoring skin barrier function.     

Rare cases of Ménière's disease in children

Classical Ménière's disease is rarely found in children and literature regarding it is scarce. In general, the frequency of Ménière's disease in children is only 0.4-7.0 per cent of that in adults. The progression pattern of Ménière's disease in children is not known well. Here, we report three cases of Ménière's disease in children less than 15 years old, treated over nine years. The three cases comprise 14- and 13-year-old boys and a nine-year-old girl. Two of the three patients initially complained only of recurrent bouts of vertigo, without any tinnitus, ear fullness or hearing impairment. In all three cases, the early pure tone audiograms showed only high tone frequency loss, regardless of subjective hearing loss, and the decrease in the hearing threshold was observed one to eight years after the dizziness attacks began. The hearing threshold was usually decreased to a level of mild or moderate hearing impairment. After diuretic treatment, vertigo was generally well controlled, and some cases showed improvement in hearing. Of the total number of patients with Ménière's disease who visited our department over nine years, 2.6 per cent (3/114) were children, and the overall incidence of Ménière's disease in children with vertigo was 2.0 per cent (3/147). In conclusion, Ménière's disease in children rarely develops and may have characteristics of high tone loss in initial audiograms.