Epidemiology and Clinical Characteristics of Enterovirus Infections in Children: A Single Center Analysis from 2006 to 2010 / 소아감염

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.

Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report

OBJECTIVE: Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. METHODS: The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. RESULTS: The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001). CONCLUSION: PDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

Evaluation of Uricult Trio Test as a Rapid Screening of UTI in Children with Fever / 소아감염

PURPOSE: The Dipslide culture test is a rapid method for diagnosis of urinary tract infection (UTI). The aim of this study is to determine the diagnostic availability of a urine Dipslide test for evaluation of UTI in febrile children. METHODS: Urine specimens from 151 febrile infants were inoculated by a routine blood agar urine culture method and the Dipslide test at the same time. Following incubation for 16-24 hours, the results of the Dipslide test were read at the next visit. Both results of Dipslide and those of routine culture were compared. RESULTS: The mean age of subjects was 15+/-10.6 months. There were 150 infants (99.3%) who had fever with a mean duration of 2.6+/-2.6 days. Thirty two infants (21.2%) were diagnosed as having UTI. Sensitivity and specificity of Uricult Trio CLED medium were 59.4% and 84.8%, respectively. Sensitivity and specificity of Uricult Trio E. coli medium were 60.0% and 96.2%, respectively. The Pearson correlation coefficient between results of Uricult Trio CLED medium and urine culture was 0.438 (P=0.01). Correlation between results of Uricult Trio E. coli medium and urine culture was 0.617 (P=0.01). CONCLUSION: The Dipslide test requires only 16-24 hours with high specificity in terms of UTI caused by E. coli without the problems associated with specimen delay. This test seems to be helpful for exclusion of UTI in febrile infants and it may reduce unnecessary hospitalization and antibiotic use. However, further studies are required before the product can be recommended as a routine diagnostic tool.

A Study on Risk Factors of Recurrent Otitis Media / 소아감염

PURPOSE: Recurrent otitis media (ROM) is usually defined as > or =3 distinct and well-documented episodes within 6 months or > or =4 episodes within 12 months. ROM is sufficiently important to warrant consideration of chemoprophylaxis, tympanostomy tube placement. There also is evidence that children with ROM are at risk for both hearing loss and speech delay. However, studies of ROM have been notably insufficient. In addition, even though environmental, racial, and sociocultural differences can affect risk factors, few studies have been conducted with regard to recurrent otitis media in Korea. METHODS: This study was conducted from July 2009 to January 2010 with infants and children who were younger than 60 months old, who visited the out-patient clinics at Han-Il General Hospital and Kyunghee University Hospital. Data were collected by interview using a pre-formed sheet. Among a total of 892 infants and children, 457 were excluded, and the remaining 435 were allocated to 104 with ROM and 331 as a control group. RESULTS: Attendance at daycare centers (P<0.001, OR=2.85), allergic rhinitis (P=0.026, OR=2.32), past history of bronchiolitis (P=0.003, OR=2.33), and low socioeconomic status (P=0.005, OR=2.00) were found to have a close significant correlation with ROM. Risk factors such as sex, having a sibling, breast-feeding, use of pacifiers, atopy, pneumococcal vaccination, influenza vaccination, smoking of parents, and indoor smoking are not relevant. CONCLUSION: Attendance at daycare centers, allergic rhinitis, past history of bronchiolitis, and low socioeconomic status have been identified as risk factors for ROM.

Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.

Development of a New Blood Typing Kit Using the Microfluidics Separation Technique / 대한혈액학회지

BACKGROUND: Blood typing is an essential test for transfusion. Generally, blood typing is performed using a slide test, tube test or microcolumn agglutination test. The aims of this study were to develop a new blood typing kit using micromachining, microfluidics and microseparation methods, and to evaluate the clinical usefulness of the new blood typing kit. METHODS: We designed and manufactured a blood typing microchip using polydimethylsiloxane (PDMS), which contained a microchannel (25~200 micrometer). The blood sample and antisera to be tested were dropped on the microwell for movement and mixing by capillary action. Once agglutination occurred, the microchannel acts as a filter and the blood type was determined by observation by the naked eye. To evaluate the newtyping kit, we tested sensitivity using artificially diluted blood and compared the results of the new typing method with the slide and tube methods using 70 samples. RESULTS: The new blood typing kit could differentiate a +4~+2 agglutination reaction, but could not detect a +1 agglutination reaction as observed by the naked eye. Among 70 samples, the results of ABO and Rh typing by the new typing method (n=66, > or = +2 agglutination reaction by the column agglutination method) were in accord with the results of the tube and slide methods, but couldnot detect agglutination in all 4 clinical samples, below a +1 agglutination reaction. CONCLUSION: The new blood typing kit is inadequate for routine use in the clinical laboratory due to low sensitivity, but with further improvement, it can be used economically, conveniently and objectively for blood typing without any special equipment. Moreover, the microfludics and separation method may be broadly applicable in other tests using the hemagglutination method.

Idiopathic Osteonecrosis of the Patella: A Case Report / 대한정형외과학회잡지

It is important to recognize idiopathic osteonecrosis or avascular necrosis of the patella not only because of its rarity but because a majority of the patients remain asymptomatic without treatment. The etiology of osteonecrosis is unclear. Certain conditions and diseases have been associated with osteonecrosis of the patella including the systemic administration of steroids, a fracture of the patella, a total knee arthroplasty and other traumatic conditions. The diagnosis is usually made with radiographs, MR imaging and a radioisotopic bone scan. It is believed to have a benign course and a favorable prognosis. We report for the first time in Korea a patient with idiopathic osteonecrosis diffusely involving the whole patella without any obvious cause.

The Relation between Early Allergic Response and Nasobronchial Relationship and the Associated Factors of Bronchial Hyperreactivity in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are evidences that allergic rhinitis and asthma represent a continuity of disease. It is known that bronchial hyperreactivity is a most contributing factor for asthma, yet it remains controversial whether there is a direct cause-and-effect relationship between the upper and lower airway. This study was performed to evaluate a direct cause-and-effect relationship between the two diseases by using early allergic responses and to define the clinical factors for predicting bronchial hyperreactivity in allergic rhinitis patients. SUBJECTS AND METHOD: Seventy three patients with allergic rhinitis and 36 patients without allergic rhinitis were included in this study, where exclusion criteria were diagnosed asthma, chronic obstructive pulmonary diseases, nasal polyp and chronic paranasal sinusitis. Nasal provocation tests with allergen were applied to 29 allergic rhinitis patients. After 30 minutes, we investigated lower airway using symptom scores, bronchial provocation test with methacholine and pulmonary function test. Bronchial provocation test with methacholine was applied to 44 allergic rhinitis patients and 36 non-allergic rhinitis patient. We checked nasal symptom scores and the change of nasal volume by VAS and acoustic rhinometry, respectively. We also investigated the incidence and the predictive factors of bronchial hyperreactivity in allergic rhinitis patients. RESULTS: The early allergic response provocated at nasal cavity had little effect on bronchus. Bronchial stimuli with methacholine did not affect nasal cavity. The incidence of bronchial hyperreactivity is significantly higher in allergic rhinitis patients than in non-allergic rhinitis patients. Type of allergic rhinitis (especially persistent, moderate-severe group) and the disease-durations are valuable predictive factors of the bronchial hyperreactivity. CONCLUSION: Although early allergic response has little effect on the nasobronchial relationship, there may be a significant correlation between allergic rhinitis and bronchial hyperreactivity. The correlation is more significant in the persistent, moderate-severe group of allergic rhinitis with long disease duration.

A case of intestinal tuberculosis complicated by miliary tuberculosis / 소아과

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.

Clinical characteristics and risk factors for staphylococcal infections in neonatal intensive care unit / 소아과

PURPOSE: The importance of staphylococcal infections in NICU has been emphasized in terms of increased resistant strains and increased incidence of morbidity and mortality. In this study, we inrestignted the clinical characteristics and risk factors for staphylococcal infections, and looked into sensitivity trends of antibiotics in the era of a high rate of methicillin-resistant staphylococcus aureus (MRSA) in our society. METHODS: This study included 240 neonates with positive blood, urine and other sites cultures for staphylococci who were admitted to NICU of Hanil General Hospital and Kyunghee University Hospital from January 2000 to December 2004. The analyses included clinical characteristics of staphylococcal infections and the relationship of incidence rate among various factors, including invasive procedures. RESULTS: For 5 years, 3,593 patients were hospitalized in the NICU and 7,481 specimens were cultured from blood, urine, and other sites. During the study period, staphylococci were isolated from 240 patients, of whom 88 patients had MRSA, 41 patients methcillin sensitive staphylococcus aureus (MSSA), 63 patients S. epidermidis, 48 patients coagulase-negative staphylococcus (CNS) except S. epidermidis infections. The risk factors associated with staphylococcal infections were less than 37 weeks of gestational age, less than 7 on a 5 minutes Apgar score, receiving TPN, applied mechanical ventilation, use of central venous catheters and other tubes. The sensitivity to vancomycin was 100 percent. A relatively high sensitivity against teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin and low sensitivity against gentamicin and erythromycin were shown. CONCLUSION: To reduce staphylococcal infections in NICU, we need to monitor and manage premature neonates from the beginning of the birth process and to avoid as many invasive procedures as possible in NICU. Considering MRSA, control of preceding factors and early use of appropriate antibiotics is expected to reduce the morbidity and mortality caused by MRSA infections.

CT Angiography in Acute Ischemic Stroke: Clinical Research / 대한뇌혈관외과학회지

OBJECTIVE: This study was designed to evaluate the feasibility and clinical implications of CT angiography (CTA) in patients with acute ischemic stroke. METHODS: From August 2004 to July 2005, 24 cases of acute ischemic stroke were prospectively included in this study. We checked location of ischemic parenchymal lesion, location of vascular occlusion, degree of collateral supply, and presence of other accompanying vascular lesions on CT and CTA, and assessed the usefulness of CTA by comparing the findings with those of diffusionweighted MR imaging and digital subtraction angiography. RESULTS: Average time required for performing CT and CTA and getting reconstructed images was 30 minutes. Location of the parenchymal lesions and the corresponding occluded or stenosed artery could be clarified in 16 cases (67%) and 20 cases (83%), respectively. There were 13 cases of severe stenosis and 7 cases of occlusion. In 7 cases of major arterial occlusion, degree of collateral circulation could be assessed as good in 5, and moderate in 2. Incidental unruptured intracranial aneurysms were identified in 5 cases. CONCLUSION: CTA could provide valuable information regarding locations of parenchymal lesion and vascular occlusion, degree of collateral supply, and presence of accompanying intracranial aneurysm in cases of acute ischemic stroke without significant time delay, thereby guiding therapeutic plan.

The Results of Modified Brostrom Procedure for the Treatment of Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate clinical and radiographical results of treatment of chronic lateral ankle instability with modified Brostrom procedure. MATERIALS AND METHODS: This is a retrospective study of 22 cases in 22 patients treated with modified Brostrom procedure under the diagnosis of chronic lateral ankle instability from May 2000 to August 2004. Average age was 32.3 years. Average follow-up period was 23 months. Preoperative and postoperative radiographs of ankle anteroposterior view, lateral view and varus stress view were analyzed. The clinical evaluation was performed according to the Americal Orthopaedic Foot and Ankle Society scales. RESULTS: After the modified Brostrom procedure, Americal Orthopaedic Foot and Ankle Society scales score was improved by average 28 points. Among the 22 cases, 13 cases were excellent, 3 cases good, 4 cases fair, and 2 cases poor with satisfaction of 73%. Five cases had intermittent ankle pain of whom 3 cases had difficulty during competitive sports activity. Lateral tilting of talus improved by average 5.4 degrees on varus stress view. CONCLUSIONS: The modified Brostrom procedure is one of the most effective methods for treating of chronic lateral ankle instability.

The Safety and Immunogenicity of a Trivalent, Live, Attenuated MMR Vaccine, Priorix (TM) / 소아과

PURPOSE: This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella (MMR) vaccine, Priorix (TM) in Korean children. METHODS: From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received Priorix (TM) at four centers: Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. RESULTS: Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days post- vaccination, were: For measles, in the age group 12-15 months, 3, 838.6 mIU/mL [3, 304.47, 4, 458.91]; in the age group 4-6 years, 1, 886.2 mIU/mL [825.83, 4, 308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1, 112.71]; in the age group 4-6 years, 2, 473.8 U/mL [1, 518.94, 4, 028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. CONCLUSION: When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine (Priorix (TM) ), adverse events were limited to those generally expected with any live vaccine. Priorix (TM) demonstrated excellent immunogenicity in this population.

The Effectiveness of Myprodol(R) on the Post-tonsillectomy Pain Control and Time to Return to Normal Daily Activities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pain is one of most troublesome discomfort after tonsillectomy. Although various analgesics have been administrated for pain control, it has not been effectively controlled until now. This study was performed to evaluate the effectiveness of Myprodol(R) codein combination analgesics, on the pain control and time to return to normal daily activities. SUBJECTS AND METHOD: Ninety adult patients undergoing tonsillectomy were included in this study. Patients were randomly divided into a Myprodol(R) group (n=30), a NSAID group (n=30) and a codeine group (n=30). They received Myprodol(R) NSAID and codeine, respectively, from the 3rd to 14th postoperative days. On the 1st, 7th and 14th postoperative days, which consisted of rising, breakfast, lunch and supper time, we assessed pain intensity by visual analogue scale. And on the 21st postoperative day, we investigated time to return to normal daily activities and adverse effects of analgesics. RESULTS: When pain intensity on the 1st postoperative day was compared, there was no significant difference among 3 groups. On the 7th postoperative day, the Myprodol(R) group showed significant pain decrease compared with the codeine group but did not with the NSAID group. On the 14th postoperative day, the Myprodol(R) group showed significant pain decrease compared with both NSAID and codeine groups. The Myprodol(R) group also showed shortened recovery time compared with the others and there was no significant adverse effects in any of the groups. CONCLUSION: We find that Myprodol(R) is an effective and safe oral analgesics for pain control and shortens time to return to normal daily activities.

A Case of Trichobezoar in a Child Who Visited with Intermittent Abdominal Pain, Nausea and Vomiting / 소아과

Bezoars are concretions commonly found in the stomach and small bowel, and four types of bezoars have been described based on their composition: trichobezoar, phytobezoar, lactorbezoar, and miscellaneous. Bezoars most often develop after gastric operations that alter the motility, emptying, and grinding of food in the stomach. Trichobezoars are most common in female children with normal gastrointestinal function and are usually associated with pica, mental retardation, and psychiatric disorders. Although uncommon, bezoars are a well-recognized cause of chronic abdominal complaints which, when undiagnosed, can result in serious complications including gastric ulceration, bleeding, perforation, intussusception and small bowel obstruction. Mortality rates of up to 30 percent have been reported in adults. Trichotillomania is behaviors surrounding hair-pulling, including stroking and playing with hair before pulling, or biting and swallowing the hair after it has been pulled(trichophagia). The most notorious of the medical sequelae of trichotillomania is the trichobezoar. We experienced a case of trichobezoar in an 11-year-old girl who frequently swallowed her hairs from age 4 years up to age 7 years, resulting in intermittent abdominal pain, nausea, and vomiting.

The Application of the Satisfaction with Amplification in Daily Life Scale in Hearing Aid Users / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The evaluation of subjective satisfaction by hearing aid users is important in view of improving pre-assessment needs and predicting treatment outcome. We evaluated the subjective satisfaction by hearing aid users accodin to the Satisfaction with Amplification in Daily Life (SADL) scale, which emphasizes nonauditory factors contributing to satisfaction as well as benefit. SUBJECTS AND METHOD: The SADL scale was completed by 42 patients who received hearing aid fitting at Kyung Hee University Hospital from October 2002 to April 2003 ; each 4 subscales of the SADL were evaluated according to the type and degree of hearing loss, the pure tone audiogram pattern and shape and type of the hearing aid. RESULTS: The mixed type hearing loss group showed higher satisfaction than the sensorineural hearing loss group with respect to positive effect and personal image. Mild and moderate hearing loss groups showed a higher overall satisfaction than severe hearing loss group. There were no statistical differences of scores between pure tone audiogram patterns, and shapes and types of hearing aids, but female users showed higher personal image score when using small (ITC, CIC) hearing aids than large (BTE, ITE) ones. Ascending, descending, and peak type pure tone audiogram patterns users showed a higher satisfaction in positive effect and service and cost when using digital hearing aids than analogue ones. CONCLUSION: Satisfaction is affected by different variables that could be measured by the SADL scales that evaluate independent domains. Assessing patient's subjective satisfaction can be helpful in planning appropriate intervention.

Calcific Tendinitis of the Rectus Femoris: A Case Report / 대한정형외과학회잡지

The most common anatomic location of calcific tendinitis is the suprasupinatus muscle of the shoulder joint. However, it is known to develop in any joint including the hip, knee, wrist, and elbow. Around the hip joint, it occurs usually in areas such as the gluteus maximus tendon, the gluteus medius tendon, and the bursa between the gluteus medius and the greater trochanter. The occurrence of calcific tendinitis in the rectus femoris is very rare. We hereby report three cases of calcific tendinitis, which developed in the rectus femoris.

The Effect of the Postoperative Weight Reduction on the Quality of the Life in the Patients with Obstructive Sleep Apnea Syndrome and Obesity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of obstructive sleep apnea syndrome (OSAS) among obese patients is about three times higher than that of non-obese patients. Obesity is the most significant risk factor of OSAS. But in the treatment of OSAS, we tended to neglect treating obesity till now. The aim of this study was to assess the effect of weight loss after surgery on the quality of the life in OSAS patients with obesity. SUBJECTS AND METHOD: Twenty OSAS patients with obesity (body mass index >25) completed the preoperative SF-36v2TM questionnaire. All patients were treated by LAUP or UPPP. Ten of them (experimental group) were induced to lose weight by 10 mg of sibutramine for 3 months whereas nothing was done in the others (control group). And then all patients completed the same questionnaire again. The changes of the SF-36v2TM scores have been assessed. RESULTS: In the experimental group, the mean BMI decreased from 30.2 to 28.4 (p<0.05), the mean physical component sum-mary of SF-36v2TM scores was increased from 50.2 to 54.6 (p<0.05) and mean mental component summary was also increased from 45.8 to 49.6 (p0.05). But in the control group, only mean mental component summary was statistically increased from 49.1 to 50.8. CONCLUSION: This study demonstrates that the trial of postoperative weight loss may improve the quality of life in OSAS patients with obesity. So we must consider the positive trial of weight loss as well as the surgeries in the treatment of OSAS patients with obesity.

Changes of Muscle Related Enzymes after Posterior Approaches to the Lumbar Spine

OBJECTIVE: Creatine phosphokinase-MM(CPK-MM) and lactate dehydrogenase(LDH) are well known indices of muscular injury. To know the degree of muscular injury during spinal surgery, the author report serial measurement of serum CPK-MM and LDH4 level. METHODS: The authors investigated 23 patients who underwent lumbar spinal surgery without bone fusion or instrumentation. Peripheral venous blood samples were serially collected 1 day before surgery, operation day, postoperative 3rd, 7th, 14th and 28th day. Postoperative back pain was measured by visual analogue scale. We evaluated the relationship between number of operation level, serial changes of serum CPK-MM, LDH4, duration of surgery and postoperative back pain. RESULTS: CPK-MM activity was higher after surgery than before it and reached at maximal level on the postoperative 3rd day, and it was returned to normal level on the postoperative 7th day. The score of postoperative back pain scale was the highest on the postoperative 3rd day. CPK-MM activity was significantly correlated with operation level, duration of surgery, and postoperative back pain(P0.05). CONCLUSION: Postoperative muscle injury is inevitable in all patient who underwent spinal surgery, and these injuries are related extent of exposure and duration of surgery. To reduce muscle injury and postoperative back pain, less invasive and shorter surgery in time is recommend.

A Case of Angioleiomyoma of the Nasal Dorsum / 대한이비인후과학회지

Angiomyoma is a benign myogenic tumor which can be found wherever smooth muscle is present. They are most commonly found in the alimentary tract, female genito-urinary tract, skin and subcutaneous tissues, but are rare in the area of the head and neck due to the scarcity of smooth muscle tissue. Because of their rarity, these tumors are often clinically misdiagnosed and identified only after histological examination. We present a case of angioleiomyoma which was found in the nasal dorsum and was excised by open rhinoplasty approach.