Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

40 years or new hires with less than 1 year of service.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Complications Following Colonoscopy in a Nationwide Standard Cohort: A Retrospective Case-control Study / 대한소화기학회지

BACKGROUND/AIMS: Despite the many reports of colonoscopy complications worldwide, few studies have been performed at the population level in Korea. In this study, a population-based study was performed to evaluate the incidence of post-colonoscopy perforations compared to a control group. METHODS: Between January 2011 and December 2011, data for all cases (age over 45) who underwent a colonoscopy were collected from National Health Insurance Service using a random sampling method. The clinical characteristics and perforation incidence (within 30 days after the colonoscopy) of cases were identified, and cases were then compared with controls who had not undergone a colonoscopy. RESULTS: Among 1,380,000 subjects, 31,177 cases and 62,354 controls were identified. Perforation occurred in 14 patients (0.04%) in the case group and one patient (<0.01%) in the control group (RR, 28.0; 95% CI 3.7–212.9, p<0.001). Subgroup analysis was followed according to the endoscopic procedure, gender and age. In subgroup analysis, colonoscopy-associated perforations occurred more in the therapeutic procedure (RR, 26; 95% CI 1.46–461.46), male (RR, 50; 95% CI 2.96–844.41), and age of 45–60 years (RR, 30; 95% CI 1.71–525.23). CONCLUSIONS: A colonoscopy procedure is related to an increased risk of perforation at the population level. In addition, the therapeutic procedure, male, and age of 45-60 years appeared to be associated with an increased risk of perforation.

Carrier frequency of SLC26A4 mutations causing inherited deafness in the Korean population

PURPOSE: The mutation of the SLC26A4 gene is the second most common cause of congenital hearing loss after GJB2 mutations. It has been identified as a major cause of autosomal recessive nonsyndromic hearing loss associated with enlarged vestibular aqueduct and Pendred syndrome. Although most studies of SLC26A4 mutations have dealt with hearing-impaired patients, there are a few reports on the frequency of these mutations in the general population. The purpose of this study was to evaluate the prevalence of SLC26A4 mutations that cause inherited deafness in the general Korean population. MATERIALS AND METHODS: We obtained blood samples from 144 Korean individuals with normal hearing. The samples were subjected to polymerase chain reaction to amplify the entire coding region of the SLC26A4 gene, followed by direct DNA sequencing. RESULTS: Sequencing analysis of this gene identified 5 different variants (c.147C>G, c.225G>C, c.1723A>G, c.2168A>G, and c.2283A>G). The pathogenic mutation c.2168A>G (p.H723R) was identified in 1.39% (2/144) of the subjects with normal hearing. CONCLUSION: These data provide information about carrier frequency for SLC26A4 mutation-associated hearing loss and have important implications for genetic diagnostic testing for inherited deafness in the Korean population.

Subclinical Ulnar Neuropathy at the Elbow in Diabetic Patients

OBJECTIVE: To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients. METHODS: One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion. RESULTS: The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove. CONCLUSION: Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.

Anterior Cervical Osteophytes Causing Dysphagia and Paradoxical Vocal Cord Motion Leading to Dyspnea and Dysphonia

Anterior cervical osteophytes are common and usually asymptomatic in elderly people. Due to mechanical compressions, inflammations, and tissues swelling of osteophytes, patients may be presented with multiple complications, such as dysphagia, dysphonia, dyspnea, and pulmonary aspiration. Paradoxical vocal cord motion is an uncommon disease characterized by vocal cord adductions during inspiration and/or expiration. This condition can create shortness of breath, wheezing, respiratory stridor or breathy dysphonia. We report a rare case demonstrating combined symptoms of dyspnea, dysphonia as well as dysphagia at the same time in a patient with asymptomatic anterior cervical osteophytes. Moreover, this is the first report demonstrating that anterior osteophytes can be a possible etiological factor for paradoxical vocal cord motion that induces serious respiratory symptoms.

Quinolone-resistant Shigella flexneri Isolated in a Patient Who Travelled to India

We report a recent case in which ciprofloxacin-resistant Shigella flexneri was isolated from a 23-yr-old female patient with a history of travel to India. Prior to her admission to our internal medicine department, she experienced symptoms of high fever and generalized weakness from continuous watery diarrhea that developed midway during the trip. S. flexneri was isolated from the stool culture. Despite initial treatment with ciprofloxacin, the stool cultures continued to show S. flexneri growth. In the susceptibility test for antibiotics of the quinolone family, the isolate showed resistance to ciprofloxacin (minimum inhibitory concentration [MIC], 8 microg/mL), norfloxacin (MIC, 32 microg/mL), ofloxacin (MIC, 8 microg/mL), nalidixic acid (MIC, 256 microg/mL), and intermediate resistance to levofloxacin (MIC, 4 microg/mL). In molecular studies for quinolone resistance related genes, plasmid borne-quinolone resistance genes such as qnrA, qnrB, qnrS, aac(6')-Ib-cr, qepA, and oqxAB were not detected. Two mutations were observed in gyrA (248C-->T, 259G-->A) and 1 mutation in parC (239G-->T). The molecular characteristics of the isolated S. flexneri showed that the isolate was more similar to the strains isolated from the dysentery outbreak in India than those isolated from Korea.

Treatment of Transient Osteoporosis of the Hip with Intravenous Zoledronate: A Case Report

Transient osteoporosis of the hip (TOH) is a rare disorder of unknown etiology that is characterized by acute onset of disabling bone pain. The locally increased bone turnover and low bone mineral density (BMD) associated with this disorder indicate a potential role for an antiresorptive agent such as bisphosphonate as a treatment. A previously healthy 46-year-old man developed the sudden onset of pain in his right buttock and inguinal area, especially during walking and caused him to limp. A thorough medical workup including X-ray, MRI, and bone SPECT revealed transient osteoporosis of the hip, and he was treated with an infusion of zoledronate (5 mg). Two weeks later, he was fully recovered from pain and the gait disturbance. A follow-up MRI of the hip joint taken after 6 months showed complete resolution. The use of intravenous zoledronate provided a successful outcome in the treatment of TOH. The possibility of TOH should be considered in patients complaining of sudden hip pain and a limping gait. MR imaging played an important role for differentiation of TOH from other aggressive conditions with long term sequelae.

A Case of Hereditary Hemorrhagic Telangiectasia Managed with Intranasal Topical Estrogen / 대한이비인후과학회지

Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder affecting blood vessels of the skin, mucous membrane and viscera. It is characterized by a clinical triad of multiple telangiectasia, recurrent hemorrhages and familial occurrence. In 80% of patients, epistaxia is the first presenting symptom. It can have a massive impact on the quality of life of those affected. Otolaryngologists should be familiar with this disease because of its potential systemic complication. Recently, we have experienced a 69 year old female complaining of melena and recurrent epistaxis for 20 years. Epistaxis was successfully managed with topical estrogen ointment.

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis

Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis

Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.

A Clinical Significance of AAO-HNS guidelines for Meniere's Disease

BACKGROUND AND OBJECTIVES:The guidelines for Meniere's disease recommended from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995, provided a basis for reporting results of the treatment used in Meniere's disease. However, these guidelines are sometimes not all inclusive and appropriate for management and reporting for some patients clinically considered having Meniere's disease. The objectives of this study is to review and analyze the symptoms, vertiginous episodes, audiometry, vestibular function test and results of the treatment in Meniere's disease and to evaluate the significance of AAO-HNS guidelines. MATERIALS AND METHOD:This study consisted of the patients with Meniere symptoms who visited the Dizziness Clinic of Ajou University Hospital between 1994 and 2001 were included in this study. The characteristics of dizziness (duration, frequency, and episodes), pure tone audiometry, vestibular function tests, and treatment results were carefully analyzed according to AAO-HNS guidelines. RESULTS:Of 550 patients with Meniere symptoms, 198 patients were in the criteria for Meniere's disease. They were classified to 75 (37.9%) of the "definite", 120 (60.6%) of the "possible", and only 3 (1.5%) of the "probable". In the "definite" group, the pure tone average (PTA) was 54.3 dB and canal paresis (CP) was showed in 33 patients (44%) with a mean CP of 53.6%, and the peak and descending types of the pure tone audiogram were dominant (62%). In the "possible" group, the PTA was 19.4dB and CP was found in 30 patients (25%) with mean CP of 50.1%. CONCLUSION:Even though AAO-HNS guidelines for Meniere's disease are helpful for communication between doctors, they should be considered to have limitations for the diagnosis and treatment in clinical practices.

Clinical Aspect of Acute Comitant Esotropia

PURPOSE: To evaluate the clinical aspect of acute comitant esotropia and the prognosis for the return of binocular function. METHODS: A clinical study was carried out for all patients who had been diagnosed as acute comitant esotropia with diplopia from July 1987 to April 1994. Each patient underwent a full opthalmological examination including history, family history, refractive error, prism cover test and sensory evaluation. RESULTS: Sixteen patients met the inclusion criteria. Ages of these patients ranged from 5 to 46 years. Three patients with history of occlusion were Swan type (type I), 5 patients without history of occlusion were Franceschetti type (type II) and 8 patients with myopia were Bielschowsky type (type III). Fifteen patients were treated with strabismus surgery and 12 patients restored binocular function. CONCLUSIONS: Acute comitant esotropia developed mostly over 5 year-old age and can be classified as three types. If the patient has no apparent cause for acute comitant esotropia, the underlying neurologic disorder should be considered. When orthophoria is achieved by strabismus surgery, the prognosis of binocular function is expected to be good.

The Effect of Mitomycin C in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the effect of intraoperative 0.2 mg/ml mitomycin C application on the success of endonasal dacryocystorhinostomy. METHODS: One hundred patients (121 eyes) were randomly divided into two groups. Group A (50 patients, 59 eyes) was treated with 0.2 mg/ml mitomycin C application during endonasal dacryocystorhinostomy and group B (50 patients, 62 eyes) was operated without application of mitomycin C. In group A, mitomycin C soaked cotton swabs were applied to the osteotomy site for five minutes. The surgical success was defined as either symptom free from epiphora or good passage of syringing. RESULTS: After the follow-up period of 6~24 months (mean 10.2 months), average diameter of mucosal osteum measured 1.17+/-0.52 mm in group A and 1.00+/-0.61 mm in group B. Granuloma around mucosal osteum was noted in 20 eyes of group A and in 31 eyes of group B. Primary success rate was 93.2% in group A and 82.3% in group B. There was no significant difference in mucosal osteum size or success rate between the two groups. CONCLUSIONS: Adjunctive use of intraoperative mitomycin C may be useful to maintain larger osteotomy size and provide better success rate of endonasal dacryocystorhinostomy.

The Results and Prognostic Factors of Mitomycin C Trabeculectomy in Neovascular Glaucoma / 영남의대학술지

BACKGROUND: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.

A Case of Buried Bumper Syndrome Replaced by Endoscopic Management / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved.

A Case of Hereditary Motor and Sensory Neuropathy Type III

Hereditary motor and sensory neuropathy type III, which is also known as Dejerine-Sottas disease, is a severe demyelinating polyneuropathy which presents from birth or infancy, and is sometimes presented as a hypotonic or floppy infant. The disease is inherited autosomal recessively and includes clinical findings of generalized muscle weakness and atrophy, with the greatest severity in distal limb muscles, areflexia, and sensory loss. The disease is characterized histologically by segmental demyelination, remyelination of the peripheral nerves, and onion bulb formations. We experienced a 12-month-old girl with delayed development, frequent respiratory infection and pes cavus. We report this case with a review of related literature.

Motor nerve conduction studies and spinal evoked potentials studiesof intercostal nerves in man

No abstract available.