Dental Care Utilization for Examination and Regional Deprivation / 예방의학회지

OBJECTIVES: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. METHODS: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). RESULTS: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. CONCLUSIONS: This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.

Unilateral vocal cord palsy occurred after difficult endotracheal intubation using intubating laryngeal mask airway: A case report / 대한마취과학회지

Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

Chest Pain due to Rapidly Developed Metastatic Spinal Tumor : A case report / 한국호스피스완화의료학회지

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.

The Effect of the Amniotic Membrane and Methocel (R) on the Postoperative Adhesion after Strabismus Surgery

PURPOSE: To evaluate the effect of amniotic membrane and additional use of 2% methylcellulose(Methocel(R)) in reducing the postoperative adhesions following strabismus surgery. METHODS: Twenty white rabbits (40 eyes) were divided into 4 groups: control group C (12 eyes), trial group A (12 eyes), trial group B (12 eyes), and normal group N (4 eyes). In group C, the superior rectus was detached and scleral scratching was done to provoke a fibrotic reaction, and then, the superior rectus was reattached to the original insertion site. In group A, the above procedure was done and in addition, the superior rectus was covered with two-folded amniotic membrane. In group B, the same procedure was done as in group A and in addition, Methocel(R) was coated between the muscle and adjacent tissues. Eight weeks later, we divided each group into two subgroups. In one group, we examined the degree of adhesion by the blunt dissection between the muscle and adjacent tissues, and in the other group, the histologic findings with a light microscope between the muscle and adjacent tissues. RESULTS: The adhesion degree on the blunt dissection and histologic examination was significantly reduced in groups A and B. But no statistically significant difference between groups A and B was shown in the postoperative adhesion. CONCLUSIONS: From these findings, it is expected that the use of amniotic membrane may reduce the postoperative adhesion after strabismus surgery and theadditional use of Methocel(R) may not be useful.

Effects of Immunostimulatory CpG-Oligodeoxynucleotides of Bronchial Asthma in Rat / 결핵

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.

Clinical Study fo Pulmonary Thromboembolism / 결핵

BACKGROUND: Pulmonary thromboembolism is relatively frequent and potentially fatal. However, it is commonly misdiagnosed. The incidence of pulmonary thromboembolism is not decreasing despite advances in diagnosis and effective prophylatic measures. Its potential for significant sequela necessitates a prompt diagnosis and treatment. Unfortunately, there are many difficulties and problems regarding accurate diagnosis. There is a low prevalence of deep vein thrombosis and pulmonary thromboembolism in Korea and only few reports on this subject are available. METHOD: The clinical features of 36 patients, who were diagnosed with pulmonary thromboembolism at the Korea University medical center, were reviewed. RESULTS: 1) There was no significant difference in prevalence between men an women, and the mean age was 50.9 years in men 59.2 years in women. 2) The frequent causes of pulmonary thromboembolism were malignancies (22.2%), surgery (22.2%), and heart disease(8.2%). Specific causes were not identified in 33.3%. 3) The most common symptom was dyspnea(72.2%), and the most common sign was tachypnea(61.1%). 4) The EKG findings were normal in 28.6%, and S1Q3T3 pulmonale pattern in 25.7%, ST or QRS changes in others. 5) The chest X-ray findings indicated pulmonary infiltation in 37.5%, cardiomegaly in 15.6%, pleural effusion in 12.5%, and normal in 27.8%. The perfusion lung scan showed a high probability in 66.7%, and intermediate or low probability in 33.3%. 6) The pulmonary arterial pressure(PAP) in the high probability groups was 57.9mmHg with a higher mortality rate(35%). CONCLUSION: Pulmonary thromboembolism is not uncommon in Korea and its clinical features do not differ greatly from those reported in the literature. When pulmonary thromboemblism of unknown causes are diagnosed, a search for an occult malignancy is recommended. Rapid diagnosis and treatment are achieved when thromboemblism is suspected.

Correlation Between Primary Tuberculous Pleurisy and NRAMP1 Genetic Polymorphism / 결핵

BACKGROUND: The phagolysosomal function of alveolar macrophage against M. tuberculosis infection is influenced by Nramp1, which is encoded by the NRAMP1 gene. There are several genetic polymorphisms in NRAMP1, and these polymorphisms affect the innate host resistance through the defect in production and function of Nramp1. To investigate this relationship, we determined the NRAMP1 genetic polymorphism in patients with primary tuberculous pleurisy was determined. METHODS : 56 Fifty-six primary tuberculous pleurisy patient (,) who were diagnosed by pleural biopsy(,) were designated to the pleurisy group and 45 healthy adults were designated to the healthy control group. 3 Three genetic polymorphisms of NRAMP1 (,) such as a single point mutation in intron 4(469+14G/C, INT4), a nonconservative single-base substitution at codon 543 that changes aspartic acid to asparagine(D543N) and a TGTG deletion in the 3' untranslated region(1729+55del4, 3'UTR)(,) were determined. Polymerase chain reaction(PCR) and polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) were used. RESULTS: The frequencies of mutanat mutant genotypes of INT4 and 3'UTR were significantly high in pleurisy group(p=0.001, p=0.023). But the frequencies of D543N were not significantly different between the both two groups(p=0.079). Odds The odds ratios(,) which are a comparison with wild genotype for determining mutant genotypes(,) were 8.022(95% confidence interval=2.422 ~26.572) for INT4 and 5.733(95% confidence interval=1.137 ~28.916) for 3'UTR which were ;these were statistically significant. But the odds ratio for D543N was not significant. In the combined analysis of the INT4 and 3'UTR polymorphisms, as compared with GG/++ homozygotes, (delete) the odds ratios were 6.000(95% confidence interval=1.461 ~ 24.640) for GC/++ genotype and 14.000(95% confidence interval=1.610 ~121.754) for GC/+del when compared with GG/++ homozygotes which ;these were statisticallysignificant. CONCLUSION: Among the NRAMP1 genetic polymorphisms, a single point mutation in intron 4(469+14G/C, INT4) and a TGTG deletion in the 3' untranslated region(1729+55del4, 3'UTR) were closely related to the primary tuberculous pleurisy.

A Case of Allergic Fungal Sinusitis / 대한이비인후과학회지

Since the initial description of allergic fungal sinusitis by Millar et al. in 1981, reported cases have been increasing. However, one case of allergic fungal sinusitis has been reported in Korea. The diagnosis can be established by demonstrating type I hypersensitivity reaction, nasal polyposis, characteristic CT scan, eosinophilic mucus without evidence of fungal invasion into sinus tissue, and a positive fungal stain or culture of sinus contents. The authors present a case which met the diagnostic criteria of allergic fungal sinusitis. This patient had nasal polyp and showed elevated level of total IgE, peripheral eosinophilia, positive MAST and strongly positive immediate skin reactivity to fungal antigens. On histologic examination, typical allergic mucin containing sheets of eosinophils, Charcot-Leyden crystals was found. Fungal hyphae were also found in the mucin content.

Effect of Korean Red Ginseng Saponin on Cochlear Damage Induced by Noise Exposure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Exposure to noise results in pertubations of cochlear microcirculation. There is evidence that these events are mediated, in part, by the calcium channel. The subsequent decrease in cochlear blood flow may lead to hypoxia and predispose to the formation of free oxygen radicals. Saponin extracted from Korean red ginseng is generally known to enhance blood flow and scavenge for free oxygen radicals. MATERIALS AND METHODS: We investigated the effect of saponin (100 mg/kg) on the cochlear damage induced by noise exposure (1500 Hz narrow band noise, 115 dB, 12hours) in guinea pigs through auditory brainstem response (ABR) and with scanning electron microscopy (SEM), RESULTS: After noise exposure, the saponin pre-treated group showed a significant decrease in the ARR threshold compared with the saponin non- treated group. Also, SEM findings of the cochlea showed that there was a minimal structural change in the outer hair cells in the saponin pre-treated group. CONCLUSION: Saponin extracted from Korean red ginseng can attenuate noise induced cochlear damage in guinea pigs.

Fat embolism syndrome with pulmonary hemorrhage of unknown origin / 결핵

Fat embolism syndrome is a rare but serious complication occurring most of the time in patients with long bone fractures. And it occasionally occurs when patient had underlying disease. For example, pancreatitis, diabetes mellitus, alcoholic liver disease and connective tissue disease can be risk factors. The 44-year old woman visited to the Korea university hospital because of sudden dry cough, blood tinged sputum, and exertional dyspnea. We found petechiae on her anterior chest wall. Chest X-ray and CT showed patchy opacities and multifocal ground-glass opacities in both lung fields. Open lung biopsy demonstrated diffuse pulmonary hemorrhage and intravascular macrovesicular fat bubbles. After conservative management, her symptoms and radiologic findings were significantly improved. We report a case of fat embolism syndrome without any known risk factors.

Effect of Panax Ginseng Saponin on Salicylate Ototoxicity in Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Large doses or long-term use of salicylate may cause reversible tinnitus and hearing loss. The exact cause of salicylate ototoxicity in unknown. Decreased cochlear blood flow following reversible biochemical changes in the cochlea seems to play an important role in salicylate ototoxicity. Protopanaxatriol and protopanaxadiol saponin of the Panax ginseng are known to have a vasodilatory effect. We investigated the effect of Panax ginseng saponin on salicylate induced hearing loss in guinea pigs. MATERIALS AND METHODS: Guinea pigs were divided into two groups. The control group was injected with salicylate (300 mg/kg, IM) and the experimental group was pretreated with Panax ginseng saponin (100 mg/kg, IP) before salicylate injection. ABR threshold was measured hourly after salicylate injection. RESULTS: The control group showed a maximal hearing loss (20+/-3.54 dBnHL) in 3 hours after the salicylate injection. Comparing with the control group, the experimental group revealed a significantly different maximal hearing loss (5+/-3.54 dBnHL). CONCLUSION: These results suggest that the protopanaxatriol and protopanaxadiol saponin of the Panax ginseng can attenuate salicylate induced hearing loss.

Amniotic Membrane Transplantation for the Conjunctival Necrosis after Scleral Gra t in the Enucleated Eye: 1 Case Report

The amniotic membrane has some characteristics. First, it does not express the human leukocyte antigens, and therefore immunologic rejection is not a concern. Second, it can be obtained easily and sufficiently. Third, because it has antimicrobial properties, transplantation of the amniotic membrane has fewer risks of post-operative infection. So it is under research for the amniotic membrane transplantation in cases of sterile corneal ulcer, pterygium excision,severe chemical and thermal corneal burns, ocular surface defects, conjunctival surface reconstruction after removal of large conjunctival lesions. We have experienced a good result of amniotic membrane transplantation for the conjunctival defect resulting from conjunctival necrosis, in enucleated eye having undergone scleral graft for scleral necrosis. Therefore, we report this case with a review of the literature.