Trends and Cut-Point Changes in Obesity Parameters by Age Groups Considering Metabolic Syndrome

BACKGROUND: Non-communicable diseases (NCDs) are an important issue worldwide. Obesity has a close relationship with NCDs. Various age-related changes should be considered when evaluating obesity. METHODS: National representative cohort data from the National Health Insurance Service National Sample Cohort from 2012 to 2013 were used. Sex-specific and age group-specific (10-year intervals) means for body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WtHR) were calculated. Optimal cut-points for obesity parameters were defined as the value predicting two or more components of metabolic syndrome (except WC). RESULTS: The mean value and optimal cut-point for BMI decreased with age for men. The mean BMI value for women increased with age, but optimal cut-points showed no remarkable difference. The mean WC of men increased with age, but the optimal cut-points were similar for age groups. For women, the mean value and optimal cut-point for WC increased with age. Regarding WtHR, the mean value and optimal cut-point increased with age for men and women. Differences across age groups were larger for women. CONCLUSION: The mean values of the obesity indices and the optimal cut-points were changed according to age groups. This study supports the necessity of applying age group-specific cut-points for the various obesity parameters.

A Case of Subdural Hematoma due to Brandt-Daroff Habituation Excercise / 대한이비인후과학회지

Subdural hematoma is a common disease of intracranial hemorrhage that accounts for 11-21% of all head trauma patients. It is defined as a hematoma that develops between dura mater and subarachnoid space. In elder patients, mild trauma may not always be accurately recognized and symptoms may not develop slowly due to the large area of subdural space. Headache is the most common symptom of subdural hematoma and may be associated with hemiplegia, dysarthria, sensation disorder, conscious disorder, and etc. We present, with a literature review, a case of a patient who developed subacute subdural hematoma after performing Brandt-Daroff habituation exercise to treat benign paroxysmal positional vertigo.

Leptomeningeal Carcinomatosis of Gastric Cancer Misdiagnosed as Vestibular Schwannoma

Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics. To our knowledge, LC from gastric cancer is very rare. In conclusion, our experience with this case suggests that clinicians should consider the possibility of delayed leptomeningeal metastasis when treating patients with gastric cancer.

A Case of Arachnoid Cyst Causing Unilateral Sudden Hearing Loss / 대한이비인후과학회지

Arachnoid cyst develops due to cerebrospinal fluid increase in the subarachnoid space and is mostly located in the middle cranial fossa, which may be associated with non-specific symptoms such as headache, unsteadiness and ataxia. However, it rarely occurs in the posterior cranial fossa and is mostly asymptomatic. When symptoms do develop, they are usually headache and psychomotor retardation, which make diagnosis very difficult. Diagnosis is generally made through magnetic resonance imaging and surgical treatment is indicated for cases where there are displacement and compression of its surrounding neurovascular component, and aggravation of symptoms. We present a case of unilateral sudden hearing loss possibly developing from an arachnoid cyst in the posterior cranial fossa with a review of literatures.

A Case of Fungal Sphenoid Sinusitis with Visual Loss / 대한의진균학회지

The maxillary sinus is the most commonly affected in the fungal infection of the sinus, but sphenoid sinus is only occasionally occurred. Because of the adjacent structures in sphenoid sinus, however, its complication may cause fatal outcome. Visual loss due to optic neuritis, which is defined as an inflammatory neuropathy of the optic nerve, is extremely rare, which may occur via direct spread of fungus. We experienced a case of fungal sphenoid sinusitis, which damaged the optic nerve and led to visual loss in a 74 year-old male. It was treated by endoscopic sinus surgery with steroid therapy. We present this case with a brief review of these disease's entities.

Predicting Factors Affecting Clinical Outcomes for Saccular Aneurysms of Posterior Inferior Cerebellar Artery with Subarachnoid Hemorrhage

OBJECTIVE: The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. METHODS: During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. RESULTS: Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. CONCLUSION: In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.

A Case of Temporal Intracerebral Hemorrhage That Presented with Sudden Bilateral Hearing Loss as the Initial Symptom

A 57-year-old man presented to the outpatient department with sudden bilateral hearing loss. The otological examination suggested bilateral severe sensorineural hearing loss. After several hours, the patient complained of a headache and became drowsy. The brain computed tomography showed a 3 x 4 cm intracerebral hemorrhage (ICH) of the left temporal lobe. Surgery was performed and 34 days after the procedure the patient was discharged from the hospital with severe bilateral sensorineural hearing loss (SNHL). Temporal lobe ICH should be considered in the differential diagnosis of patients with sudden bilateral hearing loss, regardless of the other neurological symptoms.

Isolation and characterization of avian metapneumovirus from chickens in Korea

Avian metapneumovirus (aMPV) causes upper respiratory tract infections in chickens and turkeys. Although the swollen head syndrome (SHS) associated with aMPV in chickens has been reported in Korea since 1992, this is the study isolating aMPV from chickens in this country. We examined 780 oropharyngeal swab or nasal turbinate samples collected from 130 chicken flocks to investigate the prevalence of aMPV and to isolate aMPV from chickens from 2004-2008. Twelve aMPV subtype A and 13 subtype B strains were detected from clinical samples by the aMPV subtype A and B multiplex real-time reverse transcription polymerase chain reaction (RRT-PCR). Partial sequence analysis of the G glycoprotein gene confirmed that the detected aMPVs belonged to subtypes A and B. Two aMPVs subtype A out of the 25 detected aMPVs were isolated by Vero cell passage. In animal experiments with an aMPV isolate, viral RNA was detected in nasal discharge, although no clinical signs of SHS were observed in chickens. In contrast to chickens, turkeys showed severe nasal discharge and a relatively higher titer of viral excretion than chickens. Here, we reveal the co-circulation of aMPV subtypes A and B, and isolate aMPVs from chicken flocks in Korea.

A Case of Giant Neurofibroma Arising from the Scalp / 대한이비인후과학회지

Neurofibromatosis 1 (NF-1) is an inherited neurocutaneous disorder arising from the chromosome 17q with a prevalence of one in 4,000. Neurofibroma, Cafe-au-lait spots, freckles in axilla, Lisch nodule and bony dysplasia are features of NF-1. It is diagnosed preoperatively by history taking, physical examination, CT, MRI and intraoperatively by tissue biopsy. Scalp neurofibroma accompanying pain, motor disturbance, rapid growth, and suspicious of malignancy are indications for surgical removal. We present a case of NF-1 with two giant neurofibromas (15x7x4 cm, 3x5x2 cm) on the left scalp in a patient suffering from a head injury after falling down. The neurofibromas were successfully removed after diagnosed by MRI and histology.

Role of B-type natriuretic peptide in the recurrence of atrial fibrillation after electrical cardioversion / 대한내과학회지

BACKGROUND/AIMS: No studies have conclusively determined whether the B-type natriuretic peptide (BNP) level measured before electrical cardioversion for atrial fibrillation (AF) is associated with the maintenance of sinus rhythm after the procedure. Therefore, we investigated whether the plasma BNP can predict AF recurrence in the short-term. METHODS: We prospectively recruited 20 consecutive patients with persistent AF, without symptomatic congestive heart failure. The plasma BNP was measured before and after electrical cardioversion. RESULTS: In all patients, AF was converted to normal sinus rhythm (NSR) after the procedure. NSR was maintained in 70.0% of the patients at 1 week and in 52.6% of the patients at 4 weeks. Of the patients with NSR at 1 week, five patients had relapsed by 4 weeks (4-week relapse group, 4WRG). The log BNP levels after cardioversion decreased significantly in all patients, except for the failed group at 1 week and the 4WRG. Multivariate analysis revealed that the maintenance of sinus rhythm was associated with body mass index at 1 week, and left atrial diameter (LAD) and left ventricular mass index (LVMI) at 4 weeks. 4WRG had a significantly higher baseline BNP. The baseline BNP was associated with the LVMI (R2=0.241, p=0.028) and tissue Doppler imaging (TDI) E' (R2=0.432, p=0.002). CONCLUSION: A higher plasma BNP at baseline in AF patients may help to predict the failure to maintain sinus rhythm 4 weeks after electrical cardioversion, but not the early recurrence at 1 week.

Ethmoidal Osteoid Osteoma / 대한이비인후과학회지

Osteoid osteoma is a benign osteoblastic lesion which has been reported in almost every bone of the human body, especially in the shaft of long bones. Most commonly occurring locations are in the femur, tibia and spine, while ethmoidal bone is the rarest sites of involvement. It is usually seen in the second and third decades of age and a male preponderance has been noted. Clinical features of this tumor are an intermittent vague pain, gradually increasing in severity, with nocturnal paroxysm. This pain responds characteristically to aspirin treatment. Histologically, the nidus is sharply delineated from the surrounding, variably thick layers of dense bones and has no reports of malignant transformation. The treatment of choice appears to be en bloc resection. Recently, the authors experienced a case of ethmoidal osteoid osteoma, which was removed with intranasal endoscopic approach. Hence, we report a rare case with a review of literature.

A Case of Schwannoma Arising in Pterygopalatine Fossa / 대한이비인후과학회지

Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature.

Pneumolabyrinth Resulting from Trauma: Report of Two Cases / 대한이비인후과학회지

Pneumolabyrinth is an uncommon condition in which air bubbles in the labyrinth are described, although its underlying pathophysiology is still not widely understood. It may be associated with barotrauma, stapedial surgery, cochlear implantation, head trauma, and temporal bone fracture. When it occurs, it is ususally identified on high-resolution computed tomography of the temporal bone and an early surgical intervention leads to a more rapid resolution of vestibular symptoms and preservation of existing auditory function. Recently, the authors have experienced two cases of pneumolabyrinth resulting from trauma. Hence, we report two cases with a review of literature.

The Effect of the Amniotic Membrane on Treatment of Tympanic Membrane Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. Because perforations interfere with the transmission and perception of sound, whatever the cause of the perforation, repair of the membrane is desirable. The purpose of this study is to investigate the clinical application and usefulness of allograft amniotic membrane, instead of autograft materials, in the management of tympanic membrane perforation. SUBJECTS AND METHOD: A retrospective study was performed on 14 patients who underwent myringoplasty with allograft amniotic membrane for tympanic membrane perforation from October 2006 to September 2007. Information was collected on sex, age, the cause of perforation, the perforation size, postoperative hearing result, the success rate. RESULTS: Of 14 patients, 13 patients were successfully treated by myringoplasty with allograft amniotic membrane and one patient failed due to infection. So the overall success rate was 93%. The mean air-bone gap was improved from 13.3 dB to 7.1 dB. CONCLUSION: The myringoplasty with allograft amniotic membrane is a successful procedure for the healing of tympanic membrane perforations.

Sudden Hearing Loss Caused by Acute Pontine Infarction: Reports of Two Cases / 대한이비인후과학회지

In most cases, sudden deafness results from viral infection, vascular occlusion or cochlear membrane rupture, but occasionally, its central origin can not be excluded. Although a number of signs are theoretically plausible in patients with pontine infarction such as facial weakness, lateral gaze palsy, Horner syndrome, limb dysmetria, crossed sensory loss or vertigo, isolated sudden deafness is a very rare manifestation. When pontine infarction occurs, it is usually identified on T2-weighted and diffusion-weighted magnetic resonance imaging (MRI). Early treatment with anticoagulant and antiplatelet agents leads to a more rapid resolution of symptoms and preservation of existing brain function. Recently, the authors have experienced two cases of sudden hearing loss caused by acute pontine infarction. Hence, we report two cases with a review of literature.

Rhabdomyolysis Associated With Statin Medication, Exercise and Sauna

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and other intracellular proteins and electrolytes to leak into the circulatory system. We report here on a case of rhabdomyolysis associated with statin, exercise and sauna exposure. A 63-year-old woman presented to our hospital, and she had been taking simvastatin for over 6 years due to dyslipidemia. She complained of developing myalgia and weakness of the lower extremities over the previous 5 days. She had used a sauna more than 4 hours daily for 20 years, and she had started unaccustomed exercise in the sauna 1 week prior to admission. Her serum creatine kinase concentration was 45,990 IU/L. Conservative treatment was started with the discontinuation of her statin medication, exercise and use of the sauna. Her symptoms and serum creatine kinase level decreased 1 week after admission and she was discharged with minimal residual muscle weakness.

Influence of Loneliness on Cognitive Decline among Elderly Living Alone in Korea: One Year Prospective Study

BACKGROUND: Dementia is the most important factor affecting everyday life of the elderly and there have been studies on the relationship between dementia and social withdrawal or loneliness. However, there is a lack of investigations on the relationship between loneliness and cognitive function in the elderly living alone. METHODS: Ninety five community-dwelling elderly people registered to Sungbook elderly welfare center in Seoul, who were living alone, were enrolled in the study. Personal visits by three pre-trained researchers were made during April 2006. One year later, 11 elderly dropped out, and 84 elderly were interviewed in the same way. They were interviewed based on loneliness scale, social support, Hasegawa dementia scale, instrumental activities of daily living, and depression. RESULTS: The mean age of the subjects was 78.3 years. Most of them were women (90.5%) and education level was low (no schooling in 69%). The loneliness scale did not change much during one year (P=0.63), but the instrumental activities of daily living (IADL) score had worsened from 10.5 to 11.2 (P=0.002) The mean Hasegawa dementia scale score decreased from 23.2 to 21.0 during one year (P<0.001). Multivariate regression analysis for the one-year difference in Hasegawa Dementia Scale revealed loneliness was a significant factor after adjusting for age, the level of education, social support, IADL score, and depression (regression coefficient=-0.712, P=0.02). CONCLUSION: Loneliness was associated with a decline in cognitive function in the elderly people living alone. In contrast, social withdrawal and depression had no effect on changes of cognitive function during one year.

Thromboembolism during pregnancy or postpartum / 대한내과학회지

BACKGROUND/AIMS: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. METHODS: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by chi-square-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). RESULTS: The incidence of VTE was 0.042% (17 patients, mean age 32.4+/-2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5+/-2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6+/-2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. CONCLUSIONS: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia.

A Case of Condyloma Acuminatum Presenting as a Rectal Polyp / 대한소화기내시경학회지

Condyloma acuminatum, commonly known as anogenital warts, is caused by human papillomavirus (HPV). The most common location of condyloma acuminatum in women is the vulva. Other locations are the vagina, anus and perianal area, perineum and cervix. Condyloma acuminatum most commonly occur due to receptive anal intercourse, and can enlarge to form exophytic masses on the perianal skin, but rarely involve the rectum. We experienced an occurrence of a 12 mm polypoid lesion in the rectum of a heterosexual woman detected during a colonoscopy. The polypoid lesion was excised and was diagnosed as condyloma acuminatum. The lesion was positive for HPV type 11 based on the use of an HPV DNA chip test.

A Case of Diffuse Intracapsular Hemorrhage of Thyroid Gland after Fine Needle Aspiration Biopsy / 대한이비인후과학회지

Fine-needle aspiration biopsy (FNAB) is a safe, simple, repeatable and cost-effective method, and has excellent sensitivity and specificity. Thus, it is generally used as a primary study for the diseases of salivary gland, thyroid gland, and cervical lymph node in the head and neck area. FNAB has a small number of contraindications and complications, but most of the complications are minor complications. However, uncommon complications had been reported in the literature. In this report, we describe a 63 yearold woman who experienced dyspnea caused by diffuse intracapsular hemorrhage of thyroid gland after FNAB.