Study of the Heavy Metals in Fume of Buckshot, Blood Lead Concentration and Self-Rated Health Status of National Clay Shooting Athletes / 대한스포츠의학회지

PURPOSE: This study was conducted to investigate the levels of heavy metals and self-rated health status of the national clay shooting athletes. METHODS: Fourteen subjects' blood lead level and index of liver damage (aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transferase) were measured. Heavy metal content in training environment was measured by collecting the buckshot fume. In addition, subjects completed a questionnaire assessing self-rated health status (Todai Health Index). RESULTS: Antimony and lead were detected much more than other heavy metals in the air of the shooting range. The average blood lead level of 14 subjects was significantly higher than the upper limit of normal Korean adults. Blood lead level of male is significantly higher than female and training frequency and the total training time per week were positively correlated to the blood lead level. In the result of survey on self-rated health, the higher the blood lead level, the lower the score of the common subjective physical symptoms. By age, the younger the subjects are, the higher the score of the common subjective symptoms. CONCLUSION: Although the level of heavy metals in fume of buckshot and blood lead was high, national clay shooting athletes thought that they are healthy.

Measurement of Angle Lambda Using Pentacam in Normal and Exotropic Children

PURPOSE: We measured angle lambda in normal and exotropic patients using Pentacam HR (Oculus, Wetzler, Germany). The relationship between angle lambda and refractive error was analyzed in the present study. METHODS: From December, 2013 to August, 2014, 135 eyes of 135 individuals under 16 years of age were enrolled in this study. Pentacam measures a distance between the center of the pupil and the corneal reflex point. The distance was converted to the angle lambda using the second law of cosines. All statistical analyses were performed using SPSS for Windows, version 21.0 (SPSS Inc, Chicago, IL, USA). The differences among the groups when measuring angle lambda were calculated using independent t-test, Mann-Whitney test and analysis of variance (ANOVA). Pearson's correlation test was used to analyze the correlation among the variables. RESULTS: The mean age was 7.60 +/- 3.68 years. Mean angle lambda values of the normal and exotropia groups were 4.41 +/- 2.23degrees and 4.92 +/- 2.58degrees, respectively. To evaluate the association of angle lambda and refraction measures, individuals were further classified according to the degree of myopia and hyperopia. The angle lambda values in the 3 groups according to refraction status (myopic, emmetropic and hyperopic) were 3.95 +/- 2.16degrees, 4.84 +/- 2.62degrees and 5.30 +/- 2.35degrees, respectively. A positive correlation was observed between angle lambda and spherical equivalent (correlation coefficient = 0.341, p < 0.001). A significant negative correlation was observed between angle lambda and age (correlation coefficient = -0.181, p = 0.036). There was a negative correlation between axial length and angle lambda (correlation coefficient = -0.469, p = 0.003). CONCLUSIONS: The results in this study were in agreement with the results from previous studies. Measuring the distance between the centers of the pupil and the point of corneal reflection using Pentacam is recommended as a quick, objective, quantitative and reproducible method to measure the angle lambda in children.

Clinical Outcomes of Individualized Botulinum Neurotoxin Type A Injection Techniques in Patients with Essential Blepharospasm

PURPOSE: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients. METHODS: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment. RESULTS: This study included 38 patients (26 women, 12 men; mean age, 60.6 +/- 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 +/- 12.6, 59.8 +/- 8.5, and 66.8 +/- 9.0 years, and mean BoNT-A injection dose was 38.8 +/- 11.2, 38.8 +/- 11.2, and 38.8 +/- 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 +/- 0.7 in the ODG, 1.4 +/- 0.8 in the CDG, and 1.2 +/- 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group. CONCLUSIONS: The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.

Reliability of RTVue, Visante, and Slit-Lamp Adapted Ultrasonic Pachymetry for Central Corneal Thickness Measurement

PURPOSE: To evaluate reliability of Fourier-domain optical coherence tomography (OCT) (RTVue), time-domain OCT (Visante), and slit-lamp adapted ultrasonic pachymetry (SL-US) in the measurement of central corneal thickness (CCT). MATERIALS AND METHODS: Thirty healthy volunteers visited our clinic 3 times and fifty eyes were measured by one physician. RTVue and Visante were randomly performed, and then SL-US, in which the ultrasound probe was inserted into the Goldmann tonometry mount, was done. During the second visit, each measurement was repeated 3 times. Measurements on the second visit were averaged, and agreement among the instruments was investigated with Bland-Altman plots. RESULTS: RTVue showed smaller repeatability coefficient than Visante and SL-US (4.7, 8.3, and 7.7 microm, respectively). Intersession reproducibility of RTVue and Visante was worse than their repeatability. CCT of RTVue was estimated to be maximally different by 11.8 microm from CCT of Visante and 8.8 microm from CCT of SL-US. The repeatability coefficient of SL-US was 7.7 microm and its reproducibility was similar to the repeatability. CONCLUSION: CCT measured by RTVue showed good reliability and generally agreed with Visante and SL-US. SL-US was as reliable as triple touching conventional US even with a single touch on the cornea.

Preemptive Analgesic Effect of Topical NSAIDS in Postoperative Pain Relief after LASEK

PURPOSE: To assess the preemptive analgesic effect of topical NSAIDs (0.5% ketorolac tromethamine, Acular) as postoperative pain relief in patients undergoing LASEK. METHODS: A prospective, randomized, placebo-controlled, paired eye study was performed. Patients undergoing LASEK were randomized to receive 0.5% ketorolac in one eye and 0.3% ofloxacin (placebo) in the contralateral eye at 30 minutes, 20 minutes, or ten minutes prior to LASEK. Pain was assessed using a visual analog scale of 0 to 10 in each eye 6, 12, 24, 36, 48 and 72 hours after surgery. Patients were also asked to assess the levels of glare, tearing and irritation using a visual analog scale from 0 to 10. RESULTS: A total of 62 eyes from 31 patients were enrolled in the present study. The mean postoperative pain score in the NSAID group was significantly lower than that in the placebo group at postoperative hours 6 (2.35 versus 4.97), 12 (2.52 versus 5.16), and 24 (3.84 versus 4.94) (p 0.05). Patients reported significantly less tearing and irritation in the NSAID-administered eye compared to those in the placebo eye after LASEK (p < 0.05). CONCLUSIONS: Preemptive administration of topical NSAIDs before LASEK was effective in reducing acute postoperative pain. Preemptive analgesia with topical NSAIDs may be a valuable treatment option for controlling postoperative pain following ocular surgery.

Comparison of Central Corneal Thickness after the Instillation of Topical Anesthetics: Proparacaine versus Oxybuprocaine

PURPOSE: To compare changes in human central corneal thickness after instillation of proparacaine with those after oxybuprocaine instillation, over a period of 10 minutes. METHODS: Eighteen healthy young participants were recruited. Baseline central corneal thicknesses were measured every 30 seconds for 10 minutes using a noncontact specular microscope. Changes in central corneal thickness were measured every 20 seconds for 10 minutes after the administration of one drop of 0.5% proparacaine into the right eye, and one drop of 0.4% oxybuprocaine into the left eye. RESULTS: Mean baseline central corneal thickness was 531 +/- 45 micrometer in the right eye and 531 +/- 42 micrometer in the left. The central corneal thickness after proparacaine instillation increased to 8.6 micrometer (4.5-12.6 micrometer, 95% CI) and then returned to baseline within 80 seconds. Central corneal thickness after oxybuprocaine instillation increased to 7.7 micrometer (3.6-11.2 micrometer, 95% CI) and then returned to baseline within 80 seconds. There was a second transient increase about 5 minute after proparacaine instillation but no additional transient increase after oxybuprocaine instillation. CONCLUSIONS: The severity of oxybuprocaine's effect on central corneal thickness is similar to that of proparacaine. Central corneal thickness instability may occur for 5 minutes after proparacaine administration. Therefore, changes in central corneal thickness after topical anesthetics instillation should be considered when measuring central corneal thickness.

A review of lead poisoning cases reported for recent 30 years in Korea / 대한내과학회지

BACKGROUND: Because of widespread and long-term use of lead, many lead poisoning cases were reported. Especially, in Korea including Southeast Asia, we observed non-occupational lead poisoning cases by herbal medication. METHODS: We identified total 45 cases of lead poisoning through Medric search, from 1973 to 2002. Bibliographies of relevant articles were reviewed. We arranged cases by attributes following 1) reported year, 2) age, 3) sex, 4) exposure sources, 5) exposure duration, 6) clinical manifestation, 7) treatments. RESULTS: The average age of the patients was 41.4 +/- 15.7 year-old. The distribution by sex did not have difference each other. The non-occupational lead poisoning cases were mostly caused by Chinese herbal medication. On the cases of the herbal lead poisoning, average exposure duration was 7.3 +/- 3.8 months and the various dosages were taken from 5 mg to 3 g. The major clinical symptoms were abdominal pain, headache, and constipation. The typical laboratory finding was anemia. Major treatment agent was oral penicillamine. CONCLUSION: To differential diagnose of the lead poisoning from many diseases with similar symptoms is very difficult solely on the clinical aspect. Especially, in non-occupational cases it is more difficult. In Korea, non-occupational lead poisoning cases by herbal medication have been discovered more than in western countries. We reviewed about the lead poisoning cases since 1973, so we want to make an aware of scientific and rational making and management of lead in the health supplementary food and herbal medicine.

A Case of Dengue Shock Syndrome Imported from Myanmar

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.

A Case of Dengue Shock Syndrome Imported from Myanmar

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.

Long-term Efficacy of Pneumatic Dilatation in Primary Achalasia / 대한소화기내시경학회지

BACKGROUND/AIMS: Pneumatic dilatation has been accepted as the preferred nonoperative treatment modality for primary achalasia. However, long-term effect of pneumatic dilatation on the primary achalasia has not been documented in Korea. The aim of this study was to evaluate the long- term efficacy of pneumatic dilatation and to obtain prognostic factors in primary achalasia. METHODS: Sixty four patients were enrolled retrospectively between August 1987 and July 2000. Diagnosis of primary achalasia was made by esophagogastroscopy, esophagography and esophageal manometry. Pneumatic dilatation was performed using 10 psi of 30-40 mm balloon for 1-2 sessions. We evaluated clinical efficacy of pneumatic dilatation by medical record review and phone interview, and analyzed prognostic factors by univariate and multivariate analyses. RESULTS: The clinical remission rates were 95%, 82%, and 76% at 1, 5, and 10 years, respectively. Univariate analysis showed that pneumatic dilatation was significantly more effective when the lower esophageal sphinter pressure (LESP) was reduced over 13 mmHg after treatment. Multivariate analysis demonstrated that LESP reduction tended to be a prognostic factor of primary achalasia in spite of no statistical significance. CONCLUSIONS: Pneumatic dilatation could be an effective therapy for primary achalasia. Reduction of LESP as a prognostic factor should be confirmed by a large-scale prospective study.

A Case of Duodenal Intramural Hematoma Associated with Henoch-Sch nlein Purpura / 대한소화기내시경학회지

Henoch-Sch nlein purpura is a systemic small-vessel IgA dominant vasculitis involoving the capillaries, arterioles, or venules. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement, all of which can occur in any order and at any time over several days to weeks. The central nervous system and lungs may be involved. The gastrointestinal tract is involved in more than 50 percent of patients, manifested most commonly by abdominal pain and gastrointestinal bleeding. And rarely may occur intussusception, bowel nerosis, perforation and intramural hematoma of the duodenum. We report a case of intramural hematoma of the duodenum with Henoch-Sch nlein purpura in 48 year old female patient which was demostrated by upper gastrointestinal endoscopy, abdominal CT scan, hypotonic duodenography and histologic finding of duodenal biopsy. She was treated with supportive care and improved rapidly without any serious gastrointestinal complications.

A Study on the Factors affecting Pesticide Poisoning of a Rural Population / 대한산업의학회지

The purpose of this study is to examine the pesticide use and the relationship between keeping the safety rules or use of protective equipments, and poisoning experience. For Puksan province, Choonchun county, we obtained questionnaire data concerning pesticide poisoning and relating factors from 143 people who have farmed and have sprayed pesticides. Important results are follows: 1. The rate of experiences of pesticide poisoning was 33%, and the major symptoms were dizziness(39. 13%), vomiting(20.87%), and visual opacity(11.30%). The most frequent use of pesticide was paraquat(23. 76%), and the next was organophosphates(18.35%). 2. Logistic regression and chi-square analyses showed that duration of spraying per day, following dose limits, and spraying back against wind are significantly associated with poisoning experiences(x2=5.620, p0.018, OR=0.326, CJ=0.109-0.968, OR=0.302, OR=0.097-0.939 respectively). But no associations between poisoning experiences and age, sex, use of protective equipments, and attendance of safety education. Based on these data, despite limitations in exposure assessment and recall biases, it may be necessary to devise a counterplan for development of effective safety education that prevents pesticide poisoning such as popular education in CATA pesticide project, as well as prohibition of use of hazardous pesticides that proved to be fatal.

A Case of Cavernous Hemangioma of Stomach / 대한소화기내시경학회지

A 44-year-old woman who comlpained of dizziness and generalized weakness was admitted. The hemoglobin was 6.6g/dL, hematocrit 25.5%, and serum ferritin 2.14 ng/mL Stool occult blood was positive and microcytic hypochromic anemia was found on periyheral blood smear. Gastroscopic examination showed about 2 x 1 cm sized hemispherical sebmucosal tumor on antrum. The patient underwent operatioh for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resected lesion was hemangioma of stomach. Cavernous hemangioma of stomach is a rare disease.Mostly, it has a benign course clinically, but early diagnosis is important because massive hemorrhage and anemia by chronic blood loss can occur. We report a case of hemangioma of stomach with review of literature.

A case of Churg-Strauss syndrome with manifestations of esophageal ulcer, acute acalculous cholecystitis and ischemic colitis / 대한내과학회지

No abstract available.

A Case of Multiple Right Atrial Myxomas with Pulmonary Embolism

Primary tumors of the heart are rare. Half of all cardiac tumors are myxoma of which 20% are located in the right atrium. Especially multiple myxomas in the cardiac chamber were rarely reported. Clinically, myxomas present with various manifestations due to obstruction to blood flow, embolization,and constitutional changes. The association of pulmonary emboli and right atrial myxoma has been well documented but pulmonary emboli are more likely to be asymptomatic, misdiagnosed, or diagnosed late than peripherally-sited emboli. We report a case of multiple right atrial myxomas complicating pulmonary emboli in a 73-year-old man who had features of pulmonary embolism and was found to have multiple right atrial myxomas.