Delayed recovery of a patient with obstructive azoospermia and a history of acute epididymitis / 대한생식의학회지

Obstructive azoospermia caused by acute epididymitis is usually permanent, and microsurgical vasoepididymostomy is the only reconstructive treatment option. There have been no reports of delayed recovery of sperm count after over 1 year in a patient with obstructive azoospermia related to history of acute epididymitis. We present a young male patient who had azoospermia and a history of acute epididymitis who experienced delayed recovery, with complete restoration of sperm production and the ability to conceive naturally.

Is current cardiopulmonary resuscitation guideline recommending same chest compression depth between men and women appropriate?

OBJECTIVE: This study examined whether the depth of chest compression (CC) recommended by current cardiopulmonary resuscitation guidelines is equally appropriate to both men and women. METHODS: Retrospective analysis of the chest computed tomography (CT) findings was performed. The anteroposterior diameter (APD), internal compressible depth (ICD), and anterior chest wall thickness were measured at the midpoint of the lower half of the sternum. The residual diameter (RD) for simulated CC was also obtained. If the RD was less than 20 mm, it was assumed that a potential injury would occur. RESULTS: A total of 319 adults (173 men, 141 women), who underwent chest CT at the emergency room, were enrolled. A statistically significant difference was observed between the mean APD and ICD between men and women. The mean APD and IPD were 8 mm shorter and 9.5 mm shorter, respectively, in women than in men. When adjusted for age, height, weight, and body mass index (BMI), the differences in the value of these parameters increased even more. In simulated CC with a 60 mm depth, the predictors of RD of less than 20 mm were weighed (odds ratio [OR], 0.888; 95% confidence interval [CI], 0.826–0.954; P=0.001) and BMI (OR, 0.706; 95% CI, 0.579–0.862; P=0.001), and all cases with RD of less than 20 mm were women. CONCLUSION: Chest compression of more than 60 mm may increase the potential risk of injury, particularly in women. The maximum allowable chest compression depth of less than 60 mm should be emphasized for women.

Misuse of testosterone replacement therapy in men in infertile couples and its influence on infertility treatment / 대한생식의학회지

OBJECTIVE: We investigated the clinical characteristics of men with testosterone replacement therapy (TRT)-induced hypogonadism and its effect on assisted reproductive technology (ART) in infertile couples.METHODS: This study examined the records of 20 consecutive male patients diagnosed with azoospermia or severe oligozoospermia (<5×10⁶/mL) who visited a single infertility center from January 2008 to July 2018. All patients were treated at a primary clinic for erectile dysfunction or androgen deficiency symptoms combined with low serum testosterone. All men received a phosphodiesterase 5 inhibitor and TRT with testosterone undecanoate (Nebido®) or testosterone enanthate (Jenasteron®). Patients older than 50 years or with a chronic medical disease such as diabetes were excluded.RESULTS: The mean age of patients was 37 years and the mean duration of infertility was 16.3±11.6 months. At the initial presentation, eight patients had azoospermia, nine had cryptozoospermia, and three had severe oligozoospermia. Serum follicle-stimulating hormone levels were below 1.0 mIU/mL in most patients. Three ongoing ART programs with female factor infertility were cancelled due to male spermatogenic dysfunction; two of these men had normal semen parameters in the previous cycle. After withholding TRT, serum hormone levels and sperm concentrations returned to normal range after a median duration of 8 months.CONCLUSION: TRT with high-dose testosterone can cause spermatogenic dysfunction due to suppression of the hypothalamic-pituitary-testicular axis, with adverse effects on infertility treatment programs. TRT is therefore contraindicated for infertile couples attempting to conceive, and the patient's desire for fertility must be considered before initiation of TRT in a hypogonadal man.

Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator

OBJECTIVE: Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA.METHODS: This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed.RESULTS: In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm³, P=0.020). The best cutoff platelet count was 195,000/mm³, and patients with platelet counts of < 195,000/mm³ had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm³.CONCLUSION: Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.

Hematologic parameters to predict negative cerebrospinal fluid examination results among neurologically intact patients who underwent lumbar puncture on suspicion of central nervous system infection

OBJECTIVE: Cerebrospinal fluid (CSF) examination is mandatory whenever central nervous system (CNS) infection is suspected. However, pleocytosis is not detected in a substantial number of suspected patients who undergo CSF examination. This study aimed to identify parameters that can aid in predicting negative CSF examination results (defined as a white blood cell count of 0.7, and the best cutoff values were 6.0 (accuracy 70.3%) and 12.7 mg/L (accuracy 76.2%), respectively. CONCLUSION: The neutrophil-to-lymphocyte ratio ≥6 and C-reactive protein level ≥12.7 mg/L was significantly associated with negative CSF examination result.

The Effect of Sleep Disordered Breathing on Olfactory Functions: Analysis by Apnea-Hypopnea Index

OBJECTIVES: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters. METHODS: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin’s stick test I, II (KVSS I, II) were performed. RESULTS: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell. CONCLUSION: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.

Can a Rescuer Gazing Point Intervention Improve the Depth of Chest Compressions in Hands-only Cardiopulmonary Resuscitation? A Randomized Simulation Study

PURPOSE: The aim of this study was to evaluate whether a simple verbal instruction regarding the rescuer gazing point can improve the depth of chest compressions (CCs) in the hands-only cardiopulmonary resuscitation (CPR). METHODS: Participants who took part in basic life support training courses for lay-rescuers were eligible for inclusion in this prospective, single-blinded, cluster randomized controlled study. After the training courses, both the control and the intervention groups performed the hands-only CPR for two minutes on a manikin placed on the ground. Immediately prior to CCs, instructors provided the intervention group with brief verbal instructions to look in the opposite direction of the adducted arm after placing the heel of the hand on the mid-sternum. RESULTS: One hundred and twenty-two participants (61 for each group) were enrolled in this study. The intervention group showed significantly deeper CCs than the control group (47.9±8.2 mm vs. 43±8.4 mm, p<0.01); however, there were no significant differences between the two groups in the quality of chest recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group when compared with the control group (10.3 [2.3-35.7] vs. 5.7 [0-33.0], p=0.036) CONCLUSION: Instructions to look in the opposite direction of the adducted arm during CCs improved the mean depth of CCs without significant adverse effects on the quality of recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group than the control group.

Comparison of the GlideRite to the conventional malleable stylet for endotracheal intubation by the Macintosh laryngoscope: a simulation study using manikins

OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (TETI) or in ease of handling between the two stylets. In the tongue edema model, the TETI using the CMS increased as the POGO score decreased (POGO score was negatively correlated with TETI for the CMS, Spearman’s rho=-0.518, P=0.001); this difference was not seen with the GlideRite (rho=-0.208, P=0.224). The TETI was shorter with the GlideRite than with the CMS, however, this difference was not statistically significant (15.1 vs. 18.8 seconds, P=0.385). Ease of handling was superior with the GlideRite compared with the CMS (P=0.006). CONCLUSION: Performance of the GlideRite and the CMS were not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.

Comparison of the GlideRite to the Conventional-malleable-stylet for Endotracheal Intubation by the Macintosh-laryngoscope: A Simulation Study Using Manekins

PURPOSE: The purpose of this study is to compare the effectiveness of the GlideRite with the conventional-malleable-stylet (CMS) in endotracheal intubation (ETI) using the Macintosh-laryngoscope. METHODS: This study is a randomized crossover simulation study. Participants performed ETI using both the GlideRite and the CMS in the normal airway and in a tongue edema (simulated difficult airway resulting in lower percentage of glottis opening [POGO]) model. RESULTS: In both the normal and the tongue edema models, all 36 participants performed ETI successfully using the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (T(ETI)) or ease of handling between the two stylets. In the tongue edema model, the T(ETI) increased as POGO score decreased with the CMS (POGO score showing negative correlation with T(ETI) for the CMS, Spearman's rho=-0.518, p=0.001) but not for the GlideRite (rho=-0.208, p=0.224). The T(ETI) was shorter with the GlideRite than the CMS, but without statistical significance (15.1 vs. 18.8 seconds, p=0.385). Ease of handling was superior with the GlideRite compared to the CMS (p=0.006). CONCLUSION: Performance of the GlideRite and the CMS was not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.

The Effect of Counting Numbers out for Giving Breaths on the Interrupting Time and Fraction of Chest Compressions in 2-rescuer Cardiopulmonary Resuscitation: A Manikin Pilot Study

PURPOSE: The aim of this study was to estimate the effect of counting numbers out for giving breaths on the interruption time (IT) of chest compressions (CCs) and chest compression fraction (CCF) in the 2-rescuer cardiopulmonary resuscitation (CPR). METHODS: Thirty medical students were enrolled in this randomized control simulation study, and were randomly divided into the control group and the study group. Both groups performed 2-rescuer CPR for 5-cycles with giving breaths using a bag-mask. Only participants in the study group were instructed to count numbers out for each breath verbally ("one, two") at the end point of each inspiration period and immediately perform CCs at the point of counting "two". RESULTS: However, no differences in terms of depth, rate, incorrect location, and duty cycle of CCs, as well as ventilation volume of each breath, time to delivery of two breaths, and counts of breathing during 1 minute were observed between the two groups. CONCLUSION: The study group had significantly shorter IT and higher CCF compared with the control group. And no significant differences in the other measured parameters of CPR quality were observed between the two groups.

Is There a Difference in the Effect of Thrombolytic Therapy according to the Presence of Diffusion-Weighted Imaging (DWI)-Fluid Attenuated Inversion Recovery (FLAIR) Mismatching in Patients with Acute Ischemic Stroke?

PURPOSE: We performed this study to investigate whether there is difference in the effect of intravenous (IV) thrombolysis according to the presence of diffusion-weighted imaging- fluid-attenuated inversion recovery (DWI-FLAIR) mismatch among acute ischemic stroke patients who visited the emergency department (ED) within 3 hours from the onset of symptom. METHODS: Among ED patients presenting with an acute ischemic stroke between January 2011 and May 2013, those who underwent MRI and received IV thrombolytic therapy were included in this retrospective study. Patients were divided into DWI-FLAIR mismatch and match groups and compared for their initial NIHSS (National Institutes of Health Stroke Scale), NIHSS 24-hour after the thrombolytic therapy, NIHSS on discharge, early neurologic improvement (ENI), and major neurologic improvement (MNI). RESULTS: During study period, 50 patients were finally included among 213 acute ischemic stroke patients. DWI-FLAIR mismatch group showed significantly more reduction in NIHSS 24-hour after the thrombolytic therapy and NIHSS on discharge than the match group (5.5 vs. 1.2, p<0.001, 6.0 vs. 2.3, p<0.01, respectively). Moreover, ENI and MNI occurred significantly more in DWI-FLAIR mismatch group than match group (27/36 vs. 2/14, p<0.001, 12/36 vs. 0/14, p=0.012, respectively). CONCLUSION: Among acute ischemic stroke patients who visited ED within 3 hours from the onset of symptom, those patients who had DWI-FLAIR mismatch on MRI showed significantly better response to IV thrombolytic therapy than DWI-FLAIR match group in terms of neurologic outcome.

Does Nasal Polyps Influence on the Location of Nasal Fontanelle? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the relationship between the location of the nasal fontanelle and either the chronic rhiosinusitis with nasal polyp in middle meatus (NP) or the chronic maxillary sinusitis (CMS). SUBJECTS AND METHOD: We classified the subjects without any nasal septal deviation (<5degrees) into three groups: the normal control group, the CMS group (CMS without NP) and the NP group (CRS with NP). Both angles of nasal septum and fontanelle were measured by CT imaging and nasal cavities were counted as an individual side. We compared 96 CT scans of normal controls with 79 of CMS groups and 54 of NP groups. In case of discrepancy in the locations of both fontanelles on their CT scans, we reconstructed all the images to identify the fontanelle location. The lateral side on which the fontanelle was actually located was assigned the positive angle and the medial side the negative angle to determine the presence of fontanelle deviation. The normal range of the fontanelle deviation was established by the mean angle obtained from the normal group, which included 50% of each medial and lateral side. RESULTS: The mean angles of the control group, the CMS group and the NP group were 1.34degrees, 3.47degrees, and 6.99degrees, respectively. A statistically significant relationship was noted between the control and NP group (p=0.001), but not between the control and CMS group, CMS and NP group (p=0.237 and 0.051, respectively). CONCLUSION: The nasal polyp in middle meatus influenced on the location of nasal fontanelle to lateral side compared to the normal controls.

Olfactory Identification Test Using Familiar Distracters for Koreans

OBJECTIVES: Odors used in an odor identification test should be familiar to the subject, but there are some unfamiliar distracters in Korean version of Sniffin' stick (KVSS) II identification test. In this study, we used the results of the original version of KVSS II identification to modify the KVSS II identification test. METHODS: Eighty-three participants took an original version of KVSS II identification test and a visual analogue scale of subjective odor function. KVSS II identification which has 16 items was performed to choose one out of four odors items. And visual analogue scale was checked from 0 to 10 points of their subjective olfactory function. Two weeks later they took the modified version of KVSS II identification test. Hyposmic or anosmic patients were excluded. RESULTS: The mean score of the original version of KVSS II identification and modified version of KVSS II identification were 11.3 and 12.5, respectively (P<0.05). The KVSS II identification test and subjective olfactory function were positively correlated (r=0.247, P<0.05), as were the modified KVSS II identification test and subjective olfactory function (r=0.329, P<0.05). CONCLUSION: After modification of distracters, KVSS II identification test appears to be suited for assessment of olfactory function.

The Correlation between Infection Probability Score and Procalcitonin in Emergency Department Patients

PURPOSE: Procalcitonin is a well-established biochemical marker for bacterial infection. We conducted this study to analyze the correlation between procalcitonin and Infection Probability Score (IPS), a recently introduced scoring system to predict bacterial infection in intensive care unit patients. The cutoff value of IPS corresponding to procalcitonin cutoff values was determined for procalcitonin-guided antibiotic therapy in emergency department (ED) patients. METHODS: A retrospective observation study was conducted on adult ED patients who simultaneously underwent an IPS-required blood test and procalcitonin treatment from January 1, 2012 to June 30, 2012. Based on their diagnosis at discharge, patients were grouped into a lower respiratory infection group or an "other" diagnosis group. The correlation between IPS and procalcitonin was analyzed by correlation and linear regression analysis. The IPS value corresponded to 0.25 ng/mL procalcitonin (in the lower respiratory infection group) and 0.5 ng/mL (in the other diagnosis group) as inferred by ROC curve analysis. A total of 722 cases (lower respiratory infection group: 258, other diagnosis group: 464) were included in the final analysis. RESULTS: In correlation analysis, the IPS showed a significant correlation with procalcitonin level in both groups (r=0.26, p or =0.25 microg/L in the lower respiratory infection group (area under curve: 0.783 [95% CI, 0.724-0.841], sensitivity: 77.8%, specificity: 72.3%). Also, IPS 14 could predict procalcitonin> or =0.5 microg/L in the other diagnosis group (area under curve: 0.764 [95% CI, 0.717-0.810], sensitivity: 70.1%, specificity: 74.2%). CONCLUSION: The IPS had a significant correlation with procalcitonin level and IPS> or =14 corresponded to the procalcitonin cut-off value to predict bacterial infection in ED patients. Thus, IPS> or =14 may be used to predict bacterial infection and can guide early anti-microbial therapy in ED patients when procalcitonin is not readily available.

Survey of Continuous Positive Airway Pressure Use in Korea

BACKGROUND AND OBJECTIVES: Positive airway pressure (PAP) is the most effective treatment tool for obstructive sleep apnea (OSA), however adherence rate of PAP is known to be very low. The objective of this study is to investigate the adherence rate of PAP in Korea. MATERIAL AND METHOD: We reviewed sales data from a PAP vendor. OSA patients who were referred to this vendor had a chance to experience PAP for a month. After that, patients were supposed to buy PAP or return it. We investigate the rate of patients who bought PAP, and asked the patients who had bought it whether they are still using it or not. We asked the reason to the patients who are not using it anymore. RESULTS: Among 724 OSA patients who used PAP for one month, 256 patients bought PAP and others refused it. We could survey 190 patients among 256 who had bought PAP. Among them, 34 patients did not use PAP anymore. The rest 156 patients said that they are still using it. CONCLUSION: Contrary to our expectation, only a small number of obstructive sleep apnea patients use it. We must be cautious when to prescribe PAP to obstructive sleep apnea patients.

Effects of kimchi supplementation on blood pressure and cardiac hypertrophy with varying sodium content in spontaneously hypertensive rats

We tested the effects of dietary intake of freeze-dried Korean traditional fermented cabbage (generally known as kimchi) with varying amounts of sodium on blood pressure and cardiac hypertrophy in spontaneously hypertensive rats (SHRs). Wistar-Kyoto rats (WKY), as a control group, received a regular AIN-76 diet, and the SHRs were divided into four groups. The SHR group was fed a regular diet without kimchi supplementation, the SHR-L group was fed the regular diet supplemented with low sodium kimchi containing 1.4% salt by wet weight, which was provided in a freeze-dried form, the SHR-M group was supplemented with medium levels of sodium kimchi containing 2.4% salt, and the SHR-H group was supplemented with high sodium kimchi containing 3.0% salt. Blood pressure was measured over 6 weeks, and cardiac hypertrophy was examined by measuring heart and left ventricle weights and cardiac histology. SHRs showed higher blood pressure compared to that in WKY rats, which was further elevated by consuming high sodium containing kimchi but was not influenced by supplementing with low sodium kimchi. None of the SHR groups showed significant differences in cardiac and left ventricular mass or cardiomyocyte size. Levels of serum biochemical parameters, including blood urea nitrogen, creatinine, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, sodium, and potassium were not different among the groups. Elevations in serum levels of aldosterone in SHR rats decreased in the low sodium kimchi group. These results suggest that consuming low sodium kimchi may not adversely affect blood pressure and cardiac function even under a hypertensive condition.

Clinical and Laboratory Factors Associated with Pneumonic Infiltrations on Chest Radiography Among Influenza A (H1N1) Infected Patients

PURPOSE: Pulmonary complications are the leading cause of death among patients with influenza A (H1N1) infection. Knowledge of factors associated with development of pneumonia among patients infected with influenza A (H1N1) is limited. We conducted a comparative analysis of clinical features and laboratory findings between patients with influenza A (H1N1) infection with and without infiltrations on chest radiography. METHODS: Among adults patients with influenza A (H1N1) infection confirmed by real time reverse transcriptase polymerase chain reaction (rRT-PCR), those who underwent blood tests and chest radiograph at the same time from August to December of 2009 were included in the study. A total of 141 confirmed adult patients with influenza A (H1N1) infection were finally included and were allocated to either the positive infiltration group or the negative infiltration group, as shown on chest radiography. RESULTS: Regarding clinical features, significant differences in pulse rate, respiration rate, and presence of dyspnea were observed between patients with infiltrations on chest radiography and those without infiltrations on chest radiography. According to laboratory findings, differences in leukocytosis, as well as levels of blood urea nitrogen (BUN), alanine amino transferase (ALT), actate dehydrogenase (LDH), and C-reactive protein (CRP) were observed between the two groups. As a result of multivariable analysis, dyspnea and CRP were found to be significant independent factors in association with infiltrations on chest radiography. Best cut-off value of CRP was 2.53 mg/dL with a sensitivity of 78.6% and a specificity of 73.9% (AUC: 0.830, p 2.53 mg/dL with infiltrations suggestive of pneumonia on chest radiography was observed in adult patients with influenza A (H1N1) infection.

Relation between Obesity and Bone Mineral Density and Vertebral Fractures in Korean Postmenopausal Women

PURPOSE: The traditional belief that obesity is protective against osteoporosis has been questioned. Recent epidemiologic studies show that body fat itself may be a risk factor for osteoporosis and bone fractures. Accumulating evidence suggests that metabolic syndrome and the individual components of metabolic syndrome such as hypertension, increased triglycerides, and reduced high-density lipoprotein cholesterol are also risk factors for low bone mineral density. Using a cross sectional study design, we evaluated the associations between obesity or metabolic syndrome and bone mineral density (BMD) or vertebral fracture. MATERIALS AND METHODS: A total of 907 postmenopausal healthy female subjects, aged 60-79 years, were recruited from woman hospitals in Seoul, South Korea. BMD, vetebral fracture, bone markers, and body composition including body weight, body mass index (BMI), percentage body fat, and waist circumference were measured. RESULTS: After adjusting for age, smoking status, alcohol consumption, total calcium intake, and total energy intake, waist circumference was negatively related to BMD of all sites (lumbar BMD p = 0.037, all sites of femur BMD p < 0.001) whereas body weight was still positively related to BMD of all sites (p < 0.001). Percentage body fat and waist circumference were much higher in the fracture group than the non-fracture group (p = 0.0383, 0.082 respectively). Serum glucose levels were postively correlated to lumbar BMD (p = 0.016), femoral neck BMD (p = 0.0335), and femoral trochanter BMD (p = 0.0082). Serum high density lipoprotein cholesterol (HDLC) was positively related to femoral trochanter BMD (p = 0.0366) and was lower in the control group than the fracture group (p = 0.011). CONCLUSION: In contrast to the effect favorable body weight on bone mineral density, high percentage body fat and waist circumference are related to low BMD and a vertebral fracture. Some components of metabolic syndrome were related to BMD and a vertebral fracture.

Utility of Brain Computed Tomography in Detecting Fractures of the Temporal Bones Correlated with Patterns of Fracture on High-Resolution Computed Tomography

PURPOSE: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. METHODS: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. RESULTS: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. CONCLUSION: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

A Case of Non-occulsive Mesentery Ischemia with Pulmonary Embolism due to Protein C Deficiency / 대한소화기학회지

Protein C is an important physiological anticoagulant factor. Protein C deficiency has been linked to venous thrombosis at unusual sites, including the cerebral and mesenteric veins. Hereditary protein C deficiency is inherited primarily as an autosomal dominant trait with incomplete penetrance. Protein C and S deficiencies are known to increase the risk of venous thrombosis and pulmonary thromboembolism. Testing for protein C levels and function is necessary for the detection of both type I and type II protein C deficiency. In this article, we report a case of pulmonary embolism and mesentery ischemia due to type 1 protein C deficiency.