Association between Three Heavy Metals and Dry Eye Disease in Korean Adults: Results of the Korean National Health and Nutrition Examination Survey

PURPOSE: To investigate the associations between blood heavy metal concentrations and dry eye disease using a Korean population-based survey. METHODS: This study included 23,376 participants >40 years of age who participated in the Korean National Health and Nutrition Examination Survey from 2010 to 2012. Blood concentrations of lead, cadmium, and mercury were measured in all participants. The associations between blood heavy metal concentrations and dry eye disease were assessed using multivariate logistic regression analyses. RESULTS: After adjusting for potential confounders, including age, sex, lifestyle behaviors and sociodemographic factors, the analyses revealed an increased odds ratio (OR) for dry eye disease with higher blood mercury concentrations (tertile 2: OR, 1.22; 95% confidence interval [CI], 0.91 to 1.64; tertile 3: OR, 1.39; 95% CI, 1.02 to 1.89; p = 0.039). The prevalence of dry eye disease was not associated with blood lead (tertile 2: OR, 1.15; 95% CI, 0.87 to 1.51; tertile 3: OR, 0.83; 95% CI, 0.59 to 1.16; p = 0.283) or cadmium (tertile 2: OR, 1.05; 95% CI, 0.77 to 1.44; tertile 3: OR, 1.15; 95% CI, 0.84 to 1.58; p = 0.389) concentrations. There were no significant associations between any of the three heavy metals and dry eye disease in males after adjusting for potential confounding factors, but blood mercury concentrations in females were associated with dry eye disease (tertile 2: OR, 1.18; 95% CI, 0.83 to 1.69; tertile 3: OR, 1.58; 95% CI, 1.12 to 2.24; p = 0.009). CONCLUSIONS: Mercury concentrations in blood were associated with dry eye disease. Our results suggested that controlling environmental exposure to mercury may be necessary to reduce the incidence of dry eye disease.

Seasonal Variations of Monthly Admissions and Mortality in Stroke

BACKGROUND: Seasonal variations in the occurrence and mortality from stroke patients has been widely acknowl-edged and studied extensively but without conclusive results. Several studies suggest a circannual rhythm for stroke, with a peak onset and mortality in the winter. We aimed to identify the seasonal variations of monthly admissions and mortality in stroke patients. METHODS: From 1989 to 1998, 2526 first stroke populations were enrolled in this study, which included ischemic and hemorrhagic stroke patients. Fatal events were defined as those in which the patient died within 28 days after the beginning of symptoms. We analyzed the seasonal variations of monthly admissions and mor-tality in stroke patients. RESULTS: We concluded that the monthly admissions and mortality rate of stroke patients showed seasonal variations. Monthly admissions for stroke was highest in December and lowest in August. Also, the mortality rate was highest in November (4.1%) and lowest in July (2.4%). Major causes of death were herniation, sepsis due to pneumonia, urinary tract infection, sore, and cardiovascular diseases including congestive heart failure and myocardial infarction. CONCLUSIONS: There were greater monthly admissions and mortality of strokes during the winter season in our hospital.

A Case of Cerebrotendinous Xanthomatosis

Cerebrotendinous xanthomatosis (CTX) is a rare, autosomal recessive lipid-storage disease with abnormal deposition of cholesterol and cholestanol in multiple tissues. The disease is caused by mutations in the sterol 27-hydroxylase and characterized by tendon xanthoma, premature cataracts and various neurological manifestations in the central and peripheral nervous systems. A 47-year-old man presented with unsteadiness of gait and weakness on extremities. He had a bilateral cataract extraction at the age of 30 years. Physical examination revealed bilateral elongated mass on Achilles tendons. On neurologic examination, dysarthria, spastic quadriparesis and exaggerated deep tendon reflexes were noted. Surgical excisional biopsy of Achilles tendon revealed a crystalline clefts surrounded by many multinucle-ated giant cells. A moderate degree of cerebral and cerebellar cortical atrophy and focal high signal intensities in sub-cortical white matter were noted on T2-weighted magnetic resonance images. Serum cholestanol was elevated (22 Mg/ml ; normal <2 Mg/ml), while serum cholesterol was normal (186 mg/dl ; normal <250 mg/dl). With clinical, radiologi-cal and biochemical findings, we confirmed a rare case of cerebrotendinous xanthomatosis.

A Case of Systemic Lupus Erythematosus with Chorea as an Initial Manifestation

Chorea may be a manifestation of systemic lupus erythematosus or other types of diseases such as collagen vascular diseases, antiphospholipid syndrome, Huntingtonanjx disease, or a metabolic disease. Although SLE is a well known cause of chorea, chorea as an initial manifestation of SLE is rare. The pathogenesis is unclear, and for this reason, sev-eral pathophysiologic mechanisms are suggested. We report a 19-year-old girl who presented with chorea in the absence of clinically evident SLE and had positive antiphospholipid antibodies, a normal brain image study, and a good response to steroids.

A Case of Devic's Neuromyelitis Optica with Pulmonary Tuberculosis

Neuromyelitis optica (Devic's syndrome) is characterized by acute bilateral visual loss (optic neuritis), acute trans-verse myelitis, near simultaneous development of these optic and spinal symptoms, no other symptoms and involve-ment of the central nervous system. Sporadic reports of patients with neuromyelitis optica in association with tubercu-losis confined to the lungs have appeared over the last years. A 67-year-old man presented with visual disturbance and sudden onset of lower limb weakness. On neurological examination, bilateral visual loss, flaccid paraparesis, hypesthe-sia below T2 dermatome, and extensor plantar responses were noted. Chest X-ray revealed bilateral nodular densities in the upper lung fields and a fluorochrome stain for tuberculosis was positive. Magnetic resonance imaging showed spinal cord swelling and high signal intensity (T2WI) in thoracic spinal cord. We report a case of neuromyelitis optica with pulmonary tuberculosis. It is suggested that this condition might caused by an immune reaction to tuberculosis rather than the use of antituberculosis medication.

A Case of Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome (MRS) is a rare form of hereditary angioedema characterized by a triad of orofacial swelling, relapsing facial paralysis, and a fissured tongue. However, the classic triad is not frequently seen in its complete form, and monosymptomatic or oligosymptomatic forms are more common. Case: A 20-year-old man presented with recurrent labial swelling 9 months ago and recently with a fissured tongue. The surface of the tongue showed deep furrows characteristic of lingua plicata, and an edematous enlargement was observed on the lower lips. Upon neurologic examination, a left sided facial palsy of a peripheral type was noted without abnormalities in the taste sense or lacrimation. An electromyography of the left frontal muscle showed positive sharp waves and fibrillation potentials. Biopsies performed on the lower lips revealed the congested vessels and perivascular inflammatory cells. We report a 20-year-old man with a classical triad of symptoms of Melkersson-Rosenthal syndrome.