The Association Between Hypertension and Lifestyle in Express Bus Drivers / 대한산업의학회지

OBJECTIVES: To examine whether or not there is an association between blood pressure and lifestyle habits in male express bus drivers. METHODS: The study subjects were 249 male express bus drivers. The data was obtained from annual health surveillance. A structured questionnaire was used to assess smoking, alcohol consumption, exercise, daily hours of sleep, work duration and weekly working hours. The subjects' BMI (Body Mass Index) was classified using the World Health Organization diagnostic criteria for obesity in Asians, and their blood pressure was classified according to the JNC (Joint National Committee) 7 classification. Multiple cases of logistic regression modeling were used to determine associations between hypertension and the subjects' common characteristics, lifestyle habits and obesity were used as the independent variables. RESULTS: We found that lack of sleep was associated with hypertension (OR 1.85, 95% CI 1.01~3.39) and obesity was also associated with hypertension (OR 2.81, 95% CI 1.59~4.98). CONCLUSIONS: These results indicate that daily hours of sleep and obesity were associated with hypertension in male express bus drivers. Due to the characteristics of this job, such as long hours and lack of exercise, it can result in obesity and lack of sleep, which can in turn influence occurrences of hypertension. Therefore, consideration of lack of sleep and obesity in their workers will be helpful for the management in the prevention of hypertension.

The Relationship between Job Stress and Dyslipidemia in Express Bus Drivers / 대한산업의학회지

OBJECTIVES: To examine whether or not there is a relationship between job stress and dyslipidemia in male express bus drivers. METHODS: The study subjects were 301 male express bus drivers. The data was obtained from annual health surveillance. A structured questionnaire was used to assess sociodemographics, health-related behaviors and job characteristics. Job stress was measured by the Korean Occupational Stress Scale-Short Form. A measure of blood lipid levels, comprised of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides, was dichotomized and categorized into 'high' or 'low'. Multiple logistic regression modeling was used to determine an association between job stress and dyslipidemia, with blood lipid level as the dependent variable. RESULTS: We found that high job demand was associated with high total cholesterol (OR 3.25, 95% CI 1.18-8.95) and high LDL-cholesterol (OR 4.14, 95% CI 1.18-14.44) and lack of job control was associated with low HDL-cholesterol (OR 1.92, 95% CI 1.04-3.56). CONCLUSION: These results indicate that job demand and lack of job control were associated with dyslipidemia in male express bus drivers. A job stress management program that emphasizes job demand and lack of job control is needed to prevent dyslipidemia in male express bus drivers.

A Case of Acute Myeloid Leukemia with Multilineage Dysplasia accompanying Malignant Pleural Effusion / 결핵및호흡기질환

We report a case of acute myeloid leukemia with multilineage dysplasia accompanying malignant pleural effusion. A 73 year-old male patient was admitted complaining of febrile sensations and right chest pain. The cytology of the pleural fluid revealed malignant pleural effusion showing many blasts, which had previously been identified in his bone marrow when he was diagnosed with acute myeloid leukemia with multilineage dysplasia two months earlier. His age and poor general condition had precluded chemotherapy with the exception of hydroxyurea and conservative treatment. Unfortunately, he succumbed to the disease 4.5 months after diagnosis. This case highlights the importance of determining if the pleural effusion of acute leukemia is malignant or not because it can suggest a pleural metastasis and influence the prognosis.

A Case of Therapy-Related Acute Monocytic Leukemia following Low-dose of Etoposide Treatment for Hemophagocytic Lymphohistiocytosis / 대한진단검사의학회지

We report a case of therapy-related acute myeloid leukemia after low-dosed topoisomerase II inhibitor (etoposide) treatment for hemophagocytic lymphohistiocytosis (HLH). A 62-yr-old female patient had previously been treated with a HLH-94 protocol containing a low-dose of etoposide (total dose of 300 mg/m2). Thirty-one months later, the patient was admitted to the hematology department with general weakness and upper respiratory infection symptoms. Peripheral blood smear and bone marrow study revealed acute monocytic leukemia. There was no evidence of myelodysplastic syndrome, and a cytogenetic study showed no chromosomal abnormalities.

The Effect of Superior Cervical Ganglionectomy on Recovery of Olfaction in Induced Anosmic Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was undertaken to evaluate the effect of superior cervical ganglionectomy (SCG) on anosmia, which is peripherally induced in the mice. MATERIALS AND METHOD: Three groups of mice (BCF1) were studied: normal control (nasal instillation of saline, n=6); zinc sulfate group (nasal instillation of 64 mM zinc sulfate, n=25); SCG group (superior cervical ganglionectomy after nasal instillation of 64 mM zinc sulfate, n=25). Tissues of olfactory mucosa were obtained at 1, 2, 3, 4 and 7 weeks after instillation of zinc sulfate, and processed for immunohistochemistry using antisera to olfactory marker protein (OMP) to evaluate the olfactory regeneration. RESULTS: No OMP-positive cells were observed in the first two weeks after the instillation of zinc sulfate in both zinc sulfate group and the SCG group. However, the OMP-positive cells appeared first at 3 weeks after the instillation in both groups, and gradually increased in number at 4 and 7 weeks. In the SCG group, the increase of OMP-positive cells was significantly greater than those of the zinc sulfate group. The number of OMP-positive cells in the SCG group at 7 weeks was almost similar to that of the normal control group. CONCLUSION: SCG enhances regeneration of olfactory receptor cells at 3 weeks after injury. It was inferred from the above results that SCG has a significant effect on the regeneration of olfactory receptor cells and we suggest that SCG could be an effective treatment modality for olfactory dysfunction.

The Efficacy of Stellate Ganglion Block in Olfactory Disorder Following Upper Respiratory Tract Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For patients with sudden hearing loss or retina arterial spasm, stellate ganglion block (SGB) has been used as a treatment method to increase the blood flow to the interested area. The aim of this study is to prospectively investigate the efficacy of SGB in patients with olfactory dysfunction following upper respiratory tract infection (URI). MATERIALS AND METHOD: Fifty one patients with anosmia or hyposmia following URI were included. The average duration of olfactory dysfunction was 3.5+/-8.4 years. Thirty eight patients were treated with SGB and compared with the untreated 13 patients. Buthanol threshold test and odor identification test with 16 natural fragrances were used to determine anosmia/hyposmia in these patients and to quantify the improvement of olfactory perception after SGB treatment or follow-up without treatment. RESULTS: Olfactory perception was improved significantly in the treated patients as shown by the buthanol threshold test (p<0.001) and by odor identification test (p<0.001). Subjective olfactory perception was improved in 27 of the 38 treated patients (p<0.001). No complications were observed after SGB and no one reported any worsening in olfactory perception during or after treatment. On the other hand, none of the untreated patients showed any improvement in neither of the tests or the subjective assessment. CONCLUSION: These results suggest that SGB may be a new treatment modality for olfactory dysfunction following URI.

Arsenic Trioxide (As2O3) Induced Apoptosis in NB4 Cell lines / 대한혈액학회지

BACKGROUND: Recently, inorganic arsenic trioxide (As2O3) was reported to induce complete remission in a high proportion of patients with refractory acute promyelocytic leukemia (APL). To illustrate cellular and molecular mechanisms of As2O3 in the treatment of APL, many experimental studies were performed on APL-derived cell lines in vitro. Previous studies showed that As2O3 inhibited proliferation and induced apoptosis in the APL-derived cell lines. This study was done to clarify the in vitro mechanisms of As2O3-induced apoptosis in APL-derived NB4 cell lines. METHODS: To determine the effects of As2O3 in the various concentrations, NB4 cells were cultured with 0.1 to 2micro M/L of As2O3. To assay the apoptosis in NB4 cell lines, DNA fragmentation assay and TUNEL were performed. To find out the molecular change of As2O3- induced apoptotic NB4 cell lines, RT-PCR and Western blot analysis for PML-RARalpha chimeric protein expression and flow cytometry for bcl- 2/bax expression were performed. To clarify the caspase activation pathway, Western blot analysis and flow cytometry for procaspase expression were performed. RESULTS: As2O3 induces apoptosis on NB4 cells in relatively high concentration (0.5 to 2 micro M/L) for 2 days. After 2 days of culture the PML-RARalpha chimeric protein expression decreased rapidly by Western blot and RT-PCR analysis and bcl-2 expression also decreased by flow cytometry. The expression of bax by flow cytometry showed a marked increase in high concentration (2micro M/L) but there was no change in low concentration (0.5micro M/L). In the Western blot analysis, the amount of pro`enzyme of caspase-3 was significantly decreased in the cells with high concentration (2micro M/L) compared with that in the cells with low concentration (0.5micro M/L). As2O3 induces proteolytic processing of pro-caspase 7 but not pro-caspase 9 and 8. CONCLUSION: Apoptosis of APL-derived NB4 cell lines was induced by As2O3 and progressed rapidly in higher concentrations. During apoptosis, activation of caspase-7 pathway and degradation of PML-RARalpha chimeric protein, decrease in bcl-2 and increase in bax were shown.

Distribution and synaptic organization of nitric oxide synthase immunoreactive neurons in the rat olfactory / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) has been reported to play important roles in the regulation of olfactory information in the mammarian olfactory bulb. Although the distribution of nitric oxide synthase (NOS)-immunoreactive neurons in the olfactory bulb in the rat and other animals have been investigated by light microscopy, ultrastructures of the synaptic organization between NOS-immunoreactive neurons have not been studied yet. This study was conducted in order to identify NOS- immunoreactive neurons in the rat olfactory bulb and to define their synaptic organizations under the electron microscope using the preembedding immunocytochemical method which utilizes anti-NOS antiserum. MATERIALS AND METHODS: The olfactory bulbs of the rats were cut into 50 micromiter thick vertical sections and immunostained using the ABS method. Stained sections were observed under the light microscope. Some of the stained sections, additionally stained with uranyl acetate and dehydrated, were embedded in Epon 812 and prepared into 80 nm thick sections to be observed under the electron microscope. RESULT: NOS-immunoreactive neurons of the rat olfactory bulb made up 25.0% of periglomerular cells and 18.9% of granule cells. NOS-immunoreactive periglomerular cells received synaptic input from unlabeled axon terminals of the olfactory nerve and unlabeled periglomerular cells within the glomeruli. The output targets of NOS immunoreactive periglomerular cells were unlabeled axon terminals of the olfactory nerve and unlabeled periglomerular cells. NOS-immunoreactive granule cells received synaptic input from unlabeled processes of granule cells and axon terminals of mitral cells, and made output synapses onto the unlabeled axon terminals of mitral cells. CONCLUSION: NOS-immunoreactive neurons are periglomerular cells and granule cells, and NO liberated from NOS cells may play important roles in the modulation of olfactory transmission.

Histopathologic Changes in Nasal Mucosa of Rat with Benzalkonium Chloride / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benzalkonium Chloride (BZC) is one of the most often used preservatives that has strong germicidal effect. Not only is it used for nasal drops, but also for eye drops and cosmetics. However, there have been many reports that lesions such as dermatitis and conjunctivitis are considered the results of irritation induced by BZC. We evaluated the histological changes after long-term administration of BZC on rat nasal respiratory mucosa. MATERIAL AND METHODS: We divided 40 BZC treated animals into 4 groups. First group received low-concentrated BZC solution which is commonly used for nasal sprays. Second group received high-concentrated BZC solution which is reported to induce dermatitis in human. Third and Fourth group received steroid mixed in the BZC solutions of low and high concentrations, respectively. Control group was administrated with normal saline. After 1, 2, and 4 weeks of topical administration in each group, the symptomatic and histological changes with H&E stain were observed. RESULTS: Sneezing and nose rubbing with forelegs were observed in all subgroups on the 5th day of treatment. The BZC induced lesions, including glandular formation, inflammatory cell infiltration, and edematous changes. The symptomatic and histological changes were pronounced when the duration of BZC administration was increased. Similar results were observed in groups that received steroid mixed in the BZC solution. CONCLUSION: We found that even low concentration of BZC preservative can cause nasal lesions. Thus, there is a strong need to develope a preservative that can be used safely.

The Clinical Study of Endoscopic Dacryocystorhinostomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic dacryocystorhinostomy (DCR) has become a common procedure in the otolaryngologic field thanks to the improvement of endoscope. The endoscopic procedure has several advantages, such as better hemostasis, minimal morbidity and no external scar. However, postoperative obstruction of newly created stoma is still a challenging problem. So we used mitomycin C in six cases for analyzing its effect of preventing postoperative obstruction. MATERIALS AND METHODS:We retrospectively reviewed 40 cases of endoscopic DCR performed between Mar., 1997 and Jan., 1998 to analyze preoperative causes of epiphora, postoperative complications, subjective postoperative improvement and overall success rate. RESULTS: The total success rate was 80%. The most common cause of failure was an obstruction of the newly created stoma with granulation tissue. However, we found better success rate (83%) in six cases where mitomycin C were used to prevent obstruction of stoma. CONCLUSION: Endoscopic DCR is considered to be the procedure with more advantages compared to the external approach, and mitomycin C is a valuable choice of antimetabolite to prevent postoperative granuloma formation.

A Case of Spontaneous Regression of Nasal Angiofibroma / 대한이비인후과학회지

The angiofibroma is a highly vascular and histologically benign neoplasm that appears predominantly in adolescent males. Although histologically benign, this tumor frequently has characteristic pattern of locally aggressive growth and a tendency toward base of skull and intracranial invasion. The subject of spontaneous regression of angiofibroma has been the topic of several articles discussing its hormonal dependency. Some authors argued that the tendency of this tumor to undergo remission at the time of sexual maturity was possibly due to hormonal influence. A number of recent studies have also dealt with hormonal receptors of angiofibroma tissue. In this study, we report a recent case of spontaneous remission of nasal angiofibroma found in a pregnant woman. For this case, we assumed that hormonal changes related to pregnancy contributed to the involution of this tumor, thus supporting the theory of hormonal influence and the possibility of spontaneous regression.

Sinonasal Infections in Immunocompromised Patients Undergoing Bone Marrow Transplantation / 대한이비인후과학회지

BACKGROUND: Sinonasal infection is potentially a fatal disease in the immunocompromised patients who are undergoing bone marrow transplantation(BMT). OBJECTIVES: The aim of this study is to determine the incidence, symptoms and signs, risk factors, treatment modalities and the prognostic factors of the sinonasal infections in the immunocompromised BMT patients. MATERIALS AND METHODS: We reviewed the records of 235 patients who had received bone marrow transplantation in St. Mary's hospital from December 1983 to August 1995 to determine the clinical features of sinonasal infections in these patients. RESULTS: Forty six patients(19.6%) were affected by sinonasal infections. In 40 patients(17.0%) the infection occurred before BMT. In 11 patients(4.7%), the infection occurred after BMT. Five out of 11 patients(2.1%) had previous sinonasal infections. The most common symptoms and signs were fever and rhinorrhea. Fourteen patients had no discernible symptoms or signs that suggested the presence of sinonasal infection. In our study, patients with previous history of sinonasal infection were more likely to be infected again after BMT. Medical treatment with broad-spectrum antibiotics is the initial treatment modality and surgical treatment is indicated in intractable cases. CONCLUSIONS: The immunocompromised BMT patients have high incidence of serious sinonasal infections than normal immunocompetent persons. Early detection and aggressive combined treatment with medical and surgical modalities are essential for the treatment of sinonasal infections in the BMT patients.

Effect of Topical Corticosteroid on Nasal Polyps / 대한이비인후과학회지

BACKGROUND: Topical nasal corticosteroid therapy produces clinical improvement in patients with nasal polyposis, but there are lots of controversy about the pathogenesis of nasal polyps and the mode of action of steroid therapy. OBJECTIVES: To examine the mechanism of steroid effect, we investigated the histological change in apex, body and stalk of nasal polyps individually after topical steroid therapy. MATERIALS AND METHODS: Ten patients with nasal polyposis were treated with budesonide nasal spray, 100ng(50ng/puff) twice daily in each nostril for 4 weeks. we quantified the number of inflammatory cell types and compared the histologic types and structures in each portion of nasal polyps from the patients. RESULTS: Administration of topical corticosteroid over 2 weeks caused changes in each portion of nasal polyps histologically. The histologic changes showed decreased edema and increased fibrosis under light microscope and it was evident with longer administration of the topical corticosteroid. The number of plasma cells in body portion was decreased after treatment. Electron microscopy showed that the number of degranulated granules of mast cell was increased in 2 weeks after treatment and then decreased in 4 weeks at pedicle portion of nasal polyps. CONCLUSION: The results of this study suggest that the administration of topical corticosteroid may cause activation of healing process histologically.

A Case of Hemobilia Developing Obstructive Jaundice by Blood Clots in a Patient with Cholangiocarcinoma / 대한소화기내시경학회지

Cholangiocarcinoma is a rare tumor among all populations of the world and accounts for less than 2% of cancers found at autopsy and between 10% and 20% of all primary liver cancers. The tumor originates either from the intrahepatic small duct radicles(peripheral type) or the major hepatic ducts at or near the junction of the right and left hepatic ducts(hilar type). Included in the latter are the small intraduct carcinomas arising at the bifurcation of the hepatic ducts. (continue...)

Posterior Tibial Somatosensory Evoked Potentials (PTSEPs) in Thoracic Myelopathy

The authors perforrned the posterior tibial somatosensory evoked potentials(PTSEP) on 37 patients who had typical symptoms and signs of thoracic myelopathy to evaluat the value of the PTSEP in diagnosing and differentiating among the thoracic lesions The result showed the abnormal PTSEP features which were suggestive of thoraci myelopathy in 33 of 37(89.2%). The most frequent abnormalities were the prolonged central conduction(59.5%), which were either the only one(40.6%) or combined with poor wave formation (18.9%). The second comrnon abnorrnal PTSEP findings were the decreased P1 amplitude relative to TN1 amplitude with hanng nonnal value of TN1-P1 interwave latencies (29.7%). When we divided those 37 subjects into the demyelinating (N =19) and the non-demyelinating group(N=18), the prolonged TN1-P1 interwave latencies were more prominent in the demyelinating(68.4%) than in the non-demyelinating group (50.0%). In contrast, the only relative reduction of P1 amplitude with normal central conduction was more marked in the non-demyelinating(38.9%) than in the demyelinating group(21.1%). However, both of them did not show statistical significances (p<0.254, p<0.235, respectively). The PTSEP methods were found superior to spine MRI in sensitivity in the demyeli nating group, as the PTSEP revealed abnormal findings in 12 subjects with normaI spine MRI. Therefor it is concluded that the PTSEP studies would be helpful in diagnosing the thoracic lesions, especially in patients with the demyelinating lesions. However. Those pararnmters of the prolonged central conduction(TNl-P1) or the relative amplitude redu ction of cortical patentials(P1) were not significant in differentiating the demyelinating from the non-demyelinating lesions.

Changes of Acetylcholine Receptor Antibody Concentration and Disease Severity in Myasthenia Gravis

The authors have measured the anti-AChR antibody concentration in sera of 20 myasthenia gravis and of 17 normal or other neurological diseases, to establish the radioimmunoassay(RIA) system for the AChR antibody test and to evaluate the possible relationships between changes in AChR antibody titer and clinical severity of myasthenia gravis. Significant AChR antibody titers(more than 0.04 pmol/ml) were found in 17 out of 20 myasthenia gravis (85.0%) and in 1 out of 17 norrnal or other neurological diseases (5.9%). When those 20 myasthenia gravis were classified into Ossennan's clinical stage, the AchR antibody titer rarlged from 0 to 059 pmole/ml in grade I, from 0.01 to 0.68 pmole/ml in grade IIA, from 0.15 to 1.05 pmole/ml in grade II and from 0.22 to 1.03 pmol/ml in grade III, and showed relatively good correlation with clinical severity of myasthenia gravis (Pearson correlation coef{icient 0.76). However the correlation proved to be better when the AChR antibody titers were compared with the functional activities of myasthenia gravis according to Drachman s proposal. Also the authors thought that the AChR antibody tests would be invaluable in the diagnosis of myasthenia gravis and that the extensive studies would be needed to establish the normal value of the binding AChR antibody in our laboratory.

Clinical Phenotypic Patterns of Ophthalmoplegia Plus with Ragged Red Fiber

Chronic progressive ophthalmoplegia(CPEO) is a vague clinical entity, which needs further understanding and there is still intense controversy about the classification on the Syndrome of Progressive External Ophthalmoplegia. In our country two cases of similar disease were reported with the title of oculocraniosomatic disease and CPEO with ragged red fiber. Authors experienced a 39 year-old woman with typical Kearns-Sayre syndrome(KSS) and a 44 year-old man with ophthalmoplegia plus syndrome. The case with Kearns-Sayre syndrome had an invariable triad of 1) chronic progressive external ophthalmoplegia and onset before 20 years of age, 2) retinal pigmentary degeneration of salt & pepper pattern and 3)mitochondrial abnormalities with additional findings of increased cerebrospinal fluid protein and cerebellar ataxia rhe other case with ophthalmoplegia plus with ragged red fiber syndrome had similar symptomatology to Kearns-Sayre syndrome except for typical retinal pigmentary degeneration. Both cases showed electromyographic myopathic findings and typical histopathologic features as ragged red fiber and paracrystalline mitochondrial aggregations. Therefore authors would say that these clinical different phenotypes of mitochondrial abnormality should be understood in detail by the biochemical investigations.

Clinical Studies on Associated Autoimmune Disease with Myasthenia Gravis

It is well known that myasthenia gravis is one of the most important autoimmune disease in neurology. Authors analyzed clinical and laboratory data of 118 patients with myasthenia gravis who were diagnosed at our hospital from January 1985 to August 1990. They consisted of 37 cases with ocular type, 38 cases with mild generalized type, 25 cases with moderate generalized type, 13 cases with myasthenic crisis, and 5 cases with late severe type. Of 118 patients, 11 cases were associated with thyroid diseases (9.3%), 1 with rheumatoid arthritis (0.8%), 2 with polymyositis (1.7%), 1 with insulin dependent diabetes mellitus (0.8%), and 1 with probable pemicious anernia (0.8%). Eleven cases with thyroid diseases consisted of hyperthyroidism in seven, hypothyroidism in two, and euthyroid status in three such as nontoxic goiter. Interestingly one patient was diagnosed as polyglandular autoimmune syndrome who had myasthenia gravis, thyrotoxicosis and diabetes mellitus. Symptoms of the thyroid disease preceded myasthenic symptoms in five of them. However the myasthenic symptoms appeared concomitantly in three, and followed by the clinical manifestations of thyroid disorder in three. Most of the myasthenic patients with thyroid disease showed favorable responses to medical treatment. Of the other 67 cases who were not associated with definite clinical autoimmune diseases, ten (14.9%) also revealed positive results for one of those antinuclear antibody, rheumatoid factor, antithyroglobulin antibody and antimicrosomal antibody tests.

A Comparison of Anterior Temporal and Nasopharyngeal Electrodes is the Detection of Epileptiform Activities from Temporal Lobes

A prospective study was performed to compare anterior temporal (AT) electrodes with nasopharyngeal (NP) electrodes in the detection of epileptiform discharges from temporal lobes. Three different montages including nasopharyngeal electrodes were run on 89 patients with known or suspicious temporal lobe epilepsy, During the simultaneous recording of NP and AT derivations for 5 minutes, 15 of 89 patients showed epileptiform discharges. There were 66 spikes or sharp waves, all told, 45.4%(30/66) of the epileptiform discharges were detected simultaneously by both AT and NP electrodes. The numbers of spikes or sharp waves seen on AT electrode alone- and NP electrode alone were 25 (37.9%) and 11(16 7%), respectively. 4 patients had all their epileptiforrn discharges detected only by the NP derivation whereas 2 had only by the AT derivation. Our study showed that AT and NP electrodes were complementary to each other in the detection of the temporal epileptiform activities. Further study using carefully designed montages is needed to determine the superiority of one over the other.

Usefulness of 99mTc-HMPAO SPECT in the localization of the epileptic focus in temporal lobe epilepsy: comparison with EEG, MRI and CT / 대한핵의학회잡지

No abstract available.