Relationship between Meteorological Factors and Emergency Department Visits for Epistaxis in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis may be related to changes in weather, but this relationship has not been well-defined. We investigated the effects of climate fluctuations (temperature, humidity, and barometric pressure) on the number of emergency department (ED) visits for epistaxis. SUBJECTS AND METHOD: In total, our study population included 1910 patients who visited the ED of a large, urban hospital during a 5-year period for epistaxis. Patients with clear etiology for epistaxis (trauma, iatrogenic, coagulopathy, and/or hypertension) were excluded, leaving 912 patients for subsequent analysis. Daily climate data was collected through the Korea Meteorological Administration. Correlation between epistaxis ED visits and weather variables were investigated using Poisson distribution and multiple regression analysis. The effect of climate factor was evaluated on the day and up to 3 days prior to ED presentation. Additionally, analyses were conducted separately for children ( or =65 years-old). RESULTS: Changes in the lowest temperature 2 days prior to ED presentation significantly increased the number of ED visits for epistaxis (beta=-0.043, p=0.033). No associations were found between the number of ED visits and changes in humidity or atmospheric pressure. However, in children, interday changes in the highest atmospheric pressure between 2 and 3 days prior to ED presentation were both significantly associated with increased number of epistaxis ED visits. CONCLUSION: Cold temperatures 2 days prior to ED presentation were related to the increased incidence of epistaxis. Fluctuations in barometric pressure appear to influence the number of pediatric ED visits for epistaxis.

Tullio Phenomenon Following Spontaneous Intralabyrinthine Gross Hemorrhage / 대한평형의학회지

Tullio phenomenon is a pattern of sound induced unsteadiness, imbalance or vertigo, associated with disturbances of oculomotor and postural control. As a possible cause of sudden sensorineural hearing loss, intralabyrinthine gross hemorrhage has been reported in subjects with bleeding tendency. We report a case of spontaneous intralabyrinthine hemorrhage followed by presentation of Tullio phenomenon. A 35-year-old man presented with sudden left side hearing loss and vertigo. Audiometry results indicated left total deafness and magnetic resonance images revealed left intralabyrinthine hemorrhage. At 1 month after hearing loss, sound and pressure-induced vertigo and disequilibrium newly developed. Follow-up images indicated signs of fibrosis in the left labyrinth and nystagmography results showed induction of nystagmus according to the stapedial reflex. This case suggests possibility of Tullio phenomenon in sudden sensorineural hearing loss patients.

The Characteristics of Sinonasal and Psychological Symptoms and Quality of Life in Rhinologic Patients and the Role of Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic diseases of the nose and sinuses have been shown to influence patients, not only physically but also psychologically affecting the overall well-being. We evaluated the quality of life of rhinologic patients, and the effect of surgery on them. In addition, we assessed the correlation between the symptom scores and objective findings. SUBJECTS AND METHOD: From November 2009 to January 2011, a total of 194 patients haveing nasal and sinus surgery were enrolled. They were divided into nasal cavity disease (NCD) group (n=103) and chronic rhinosinusitis (CRS) group (n=91). These patients had to fill out a questionnaire at different points, at 1 day, 1 month, 3 and 6 months prior to surgery. The normal control group (n=30) also had to fill out four questionnaires: our questionnaires were Sinonasal Outcome Test-20 (SNOT-20), Rhinosinusitis Disability Index (RSDI), Version 2 of Short-Form 36 item Health Survey (SF-36v2(TM)), Symptom Checklist-90-Revised (SCL-90-R). For the CRS group, Lund-Mackay score was calculated using CT scans. RESULTS: Both experimental groups showed more severe scores than the control group. The CRS group exhibited more severe symptoms than the NCD group. Both experimental groups achieved significant improvements after surgery. CRS group showed more significant improvement than the NCD group in SNOT-20. The Lund-Mackay score showed no significant correlation with the subjective symptom scores. CONCLUSION: Chronic rhinologic diseases affect the quality of life. CRS patients show more severe scores than the NCD patients. CRS patients have more improved effectiveness than NCD patients after surgical treatment. Objective conditions and subjective symptoms may be correlated inconsistently, and the evaluation for the overall quality of life is important to reflect on the therapeutic effect.

Morphologic Analysis of Crista Galli Using Computed Tomography

OBJECTIVE: We often observe the variation of Crista galli (CG) which lies in the midline above the cribriform plate on computed tomography (CT) scans. We investigated the variations in CG and the factors which affect its pneumatization. MATERIALS AND METHODS: We analyzed the CT images of 818 chronic rhinosinusitis patients between July 2003 and July 2011. We investigated height, position relative to the cribriform plate, degree of pneumatization, and cell origin for the pneumatization in CG. We analyzed the relationship between several factors (age, sex, and position of CG) and pneumatization of CG. RESULTS: The average height of CG was 17.98 mm. In 13.9% of subjects, the base of CG did not extend below the level of the cribriform plate. In 84.2%, CG extended less than 50% of its height below the cribriform plate. In 1.8%, CG extended more than 50% of its height below the cribriform plate. Pneumatization of CG was found in 12.2%. Except one, every pneumatization was connected with the frontal sinus. The rate of pneumatization was significantly different depending on age. CONCLUSION: Our study demonstrated that CG showed various morphology and pneumatizaiton. The pneumatization of CG was mainly originated from frontal sinus and related to aging.

A Case of Ectopic Salivary Gland with Fistula in the Anterior Neck / 대한이비인후과학회지

Ectopic salivary gland tissue represents an uncommon lesion, usually presenting as a discharging fistula in the anterior lower neck. Though the origin of this entity still remains unclear, it is thought to be a heteroplasia of the epithelium of the precervical sinus of His. We have experienced a case of ectopic salivary gland with cervical fistula in a 10-year-old. This was thought clinically to be the second branchial cleft cyst, but the pathology showed an ectopic salivary gland. This should be considered as one of the causes of a cystic neck mass or fistula in children.

Psychiatric Investigation by Using the Minnesota Multiphasic Personality Inventory in Patients with Chronic Constipation

PURPOSE: Current study was designed to understand the personality and emotional composition of patients with chronic constipation. Specifically, the personality differences were evaluated in the ramified subgroups based on the physiologic characteristics. METHODS: Forty patients (31 females and 9 males) of a mean age of 48 (range, 16~86) years underwent the MMPI among 310 patients with chronic constipation. MMPI (Minnesota Multiphasic Personality Inventory) profiles were utilized for psychologic assessment for all patients prior to making diagnosis. Three validity scales of MMPI included L (Lie scale), F (Infrequency scale), K (Suppressor scale). Ten clinical scales included HS (hypochondriasis), DP (depression), HY (hysteria), PD (psychopathic deviant), MF (masculinity- feminity), PA (paranoia), PT (psychasthenia), SC (schizophrenia), MA (mania), SI (social introversion). On the basis of findings with use of anorectal physiologic studies, subgroups were categorized as patients with rectocele (A1, n=22), patient without rectocele (A2, n=18), patients with nonrelaxing puborectalis syndrome (B1, n=10), patients without nonrelaxing puborectalis syndrome (B2, n=30). The MMPI profiles were compared between subgroup patients. RESULTS: In overall patients, mean scores for scales HS, DP were elevated as compared with mean profiles (60~65 and 45~55, respectively). Male patients showed higher mean scores for scale SI than those of female patients (male vs. female; 63.5 vs. 53.9, P<0.05). A1 group showed higher mean scores for PD scale than those of A2 group (A1 vs. A2; 57.4 vs. 49.8, P=0.01). B1 group showed higher mean scores for DP scale than those of B2 group (B1 vs. B2; 67.5 vs. 59.8, P<0.05). CONCLUSIONS: Present series provided that the MMPI is a valuable tool for assessing the psychologic functioning of patients with chronic constipation. It has revealed a different personality and emotional composition in the subgroup patients based on the anorectal physiologic studies. An aspect of social introversion, psychopathic deviant and depression should be emphasized. These findings can provide the fundamental information for guideline of future diagnostic evaluation and therapy in the patients with chronic constipation.

Development of Second Stage Software in the Anal Sphincter Control System Based on the Anal Electromyography, and Investigation of Therapeutic Outcome of the Patients withChronic

To eliminate the inconvenient shortcomings of our formerly designed system for the biofeedback treatment, the development of second stage software was indispensable. PURPOSE: The aims of current study were to supplement the prototype software, and to improve the application software for the database management system. Moreover, we assessed the practical value and outcome of biofeedback therapy for the patients with functional evacuation disorders by using the upgraded system. METHODS: A new system was worked out a design to be composed of Windows based GUI (graphical user interface), DB (database) management software, and networking system. Main software performs a signal processing and a protocol making mode to train pelvic sphincter. DB program administers patient profiles and the recorded signal data. Networking system was designed to execute RS-232C serial communication of signal data with use of fast ethernet LAN networking. To affirm the reproducibility of signal display for the clinical practice, system was applied to 5 healthy volunteers. To evaluate the practical appraisal, system was applied to 27 patients with functional evacuation disorders who were undertaken anorectal physiologic tests. Patient groups were categorized as nonrelaxing puborectalis group (group I, n=17), incontinencegroup (group II, n=10). Overall patients were underwent a mean 3.7 (range, 2~10) sessions of biofeedback treatment, and the outcome was analysed in the period of 5.8 (range, 3~12) months follow-up. RESULTS: Signal data not having drift or noise were adequately processed and displayed in a real time. Specifically, data upload with use of multi-processing overay display function was appropriately embodied. Overall data and profiles of patients groups were safely saved, sorted, and reproduced by using the upgrading database management software. Regarding to the therapeutic outcomes, 63 percent of 27 overall patients (12 of 17 patients in group I, 5 of 10 patients in group II) were improved. The subjective symptoms of 2 patients in group I were recurred in a period of 3 months follow-up. CONCLUSIONS: Hardware and software functions of upgraded system were applicable to the Windows environment of personal computer. A developed system with second stage software made it possible to perform biofeedback treatment. Specifically, current results could be useful for the improvement of the motivation and patient's willingness in the self-learning process of biofeedback treatment.

Malignant Metachronous Cancers (Breast Cancer, Small Bowel Leiomyosarcoma) Associated with Von Recklinghausen Disease (NF 1)

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that occurs once in 3,000 live births. Patients with NF1 are prone to develop malignancies, particularly neural tumors, that is, malignant schwannoma and glioma in adults. For non-neural tumors, the NF1 incidence is increased in rhabdomyosarcomas, leukemia, malignant melanomas, breast cancer, lung cancer, thyroid cancer, and other organ cancers. The NF1 gene seems to increase the risk for carcinogenesis. A case of NF1 associated with metachronous cancers, such as breast cancer (1991) and small-bowel leiomyosarcoma (1997), in the same patient is reported. Investigation of the patient's family revealed four further cases (offsprings) of multiple neurofibromatosis. The relevant literature on the subject is reviewed.

Postoperative Changes of Ultrasonographic Pyloric Mass in Infantile Hypertrophic Pyloric Stenosis

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a well-recognized cause of vomiting in infancy and is easily cured by a Ramstedt pyloromyotomy. However there have been no reports on the postoperative appearance of a pyloric mass in Korea. METHODS: Twenty infants with IHPS and 20 control infants were studied ultrasonographically during the first year of life at a regular interval. According to examination intervals, the IHPS infants (n=20) were divided into three groups: Group A (3 months, n=6), B (6 months, n=7), and C (12 months, n=7). At each examination, measurements were obtained concerning the length of the pyloric canal and the muscular thickness. RESULTS: The mean preoperative length of the pylorus of the IHPS group was 19.4+/-3.64 mm, ranging from 17 to 30 mm (control: 7.73+/-2.67 mm) (p<0.0001). The mean pyloric muscle thickness of the IHPS group was 5.08+/-0.67 mm, ranging from 3.5 to 6 mm (control: 2.37+/-0.58 mm) (p<0.0001). The preoperative and postoperative measurements were subsequently compared. Postoperatively, the length of the pylorus averaged 22.0+/-2.66 mm, and the muscular thickness was 6.53+/-1.68 mm (p<0.0001). The reduction rates in pyloric length were 23.5%, 46.3%, and 53.4% for the respective groups. Also, the muscle-thickness reduction rates were 31.8%, 48.9%, and 57.8% respectively. At 6 months after the operation, the pyloric muscular thickness was in the normal control range, and the pyloric length was reduced to the normal range after 12 months. CONCLUSIONS: This prospective study suggests that the pyloric mass undergoes a rapid reduction in size in the first 6 months, followed by a more gradual reduction to a normal value by 12 months after a pyloromyotomy.

A case of fabry's disease with chronic renal failure effectively managed with CAPD / 대한신장학회잡지

No abstract available.

Clinical Study on Acute Myocardial Infarction

A retrospective clinical study was done on 78 cases of acute myocardial infarction admitted to Jeonje Presbyterian Medical Center from Jenuary 1972 to June 1982. The following results had been obtained. 1) The ratio of male to female patients with acute myocardial infarction was 3.9:1. Most patients were in the age group between the 6th and 7th decade(64%). 2) The number of patients admitted annually was about 8, and was increased 2.5 folds in the latter 5 years as compared with the first 5 years. 3) The most common past illnesses of patients with acute myocardial infarction were coronary insufficiency with angina pectoris, hypertension, previous myocardial infarction, diabetes mellitus, valvular heart disease and hyperthyroidism in order named. The patients without significant past illness amount to 41.0%. 4) Among the patients with acute myocardial infarction smokers were 1.9 times as many as non-smokers. 5) The chief complaints of the patients with acute myocardial infarction on admission were chest pain(60.3%), dyspnea(26.9%) and mental change(6.4%). 6) The distribution of the patients withacute myocardial infarction by Killip classification was as follows: Class I, 47.4%, class II, 16.7%, class III, 16.7% and class IV, 19.2%. 7) The most common location of acute myocardial infarction by EKG was anterior wall of the myocardium at 79.5%. 8) The patients with arrhythmia by EKG amount to 53.8% and conduction disturbance 20.5%. 9) The patients with acute myocardial infarction who expired during admission were 23%. The ratio of male to female was 2.6:1. Among the expired patients Killip class IV was 80.8% and anterior wall infarction was 77.8%.

Five Cases of Sick-Sinus Syndrome & Implantation of Pacemaker

This paper summarizes our experience of five cases of sick-sinus syndrome, hospitalized at Presbyterian Medical Center in Jeonju from January, 1980 to January, 1983. Diagnosis was made depending on clinical symptoms, physical examination, EKG and provocative test with atropine sulfate. The etiologies of 4 cases were as follows: coronary disease, hypertension, myocarditis, coronary disease with hypertension; but, the etiology of one case was not clear. Symptoms, including syncope, dizziness, and palpitation subsided after implanting the temporary pacemaker. A permanent pacemaker was implanted in all but one case, who had myocarditis.