Raising awareness of recurrent cystitis among women

Recurrent cystitis is a common condition affecting women, often causing discomfort and negatively impacting their quality of life. Despite the high level of morbidity, this condition is frequently overlooked due to relatively low fatality rate. This lack of adequate awareness about recurrent cystitis has led to increased healthcare costs, inappropriate utilization of medical resources, and growing antibiotic resistance. Therefore, there is an urgent need to raise awareness and improve the strategies employed for managing recurrent cystitis.Current Concepts: The socioeconomic burden imposed by recurrent cystitis is substantial, with billions of dollars spent worldwide every year on its diagnosis and treatment. Unnecessary emergency room visits and loss of labor due to illness further exacerbate the costs. Additionally, recurrent cystitis significantly diminishes patients’ quality of life, leading to psychological challenges such as anxiety and depression. Recent research has highlighted the importance of identifying underlying conditions and modifying lifestyle behaviors, in addition to actual treatment, to improve patients’ quality of life.Discussion and Conclusion: It is important to implement various strategies to raise awareness and foster interest in recurrent cystitis. These include patient education, public awareness campaigns, healthcare professional training, online resources, and research collaboration. By increasing awareness and adopting a proactive approach to managing recurrent cystitis, we can improve patient outcomes and enhance the overall efficiency of the healthcare system, ultimately benefiting patients, medical staff, and society as a whole.

Schisandrol A and gomisin N from Schisandra chinensis extract improve hypogonadism via anti-oxidative stress in TM3 Leydig cells

BACKGROUND/OBJECTIVES@#Male hypogonadism is a condition where the body does not produce enough testosterone and significantly impacts health. Age, obesity, genetics, and oxidative stress are some physiological factors that may contribute to testosterone deficiency.Previous studies have shown many pharmacological benefits of Schisandra chinensis (S. chinensis) Baillon as an anti-inflammatory and antioxidant. However, the molecular mechanism of attenuating hypogonadism is yet to be well established. This research was undertaken to study the effects of S. chinensis extract (SCE) on testosterone deficiency.MATERIALS/METHODS: S. chinensis fruit was pulverized and extracted using 60% aqueous ethanol. HPLC analysis was performed to analyze and quantify the lignans of the SCE. @*RESULTS@#The 2,2-diphenyl-2-picrylhydrazyl and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) scavenging assays confirmed that the SCE and its major lignans (schisandrol A and gomisin N) inhibit oxidative stress. Effects of SCE analysis on the testosterone level under oxidative stress conditions revealed that both schisandrol A and gomisin N were able to recover the lowered testosterone levels. Through mRNA expression of TM3 Leydig cell, we observed that the SCE lignans were able to induce the enzymes involved in testosterone biosynthesis-related genes such as 3β-HSD4 (P < 0.01 for SCE, and P < 0.001 for schisandrol A and gomisin N), 17β-HSD3 (P < 0.001 for SCE, schisandrol A and gomisin N), and 17, 20-desmolase (P < 0.01 for schisandrol A, and P < 0.001 for SCE and gomisin N). @*CONCLUSIONS@#These results support that SCE and its active components could be potential therapeutic agents for regulating and increasing testosterone production.

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes

Background@#Sedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes. @*Methods@#A retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates. @*Results@#The cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction. @*Conclusion@#Sedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.

Enterovesical Fistula From Meckel Diverticulum

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

Enterovesical Fistula From Meckel Diverticulum

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

Invasive Cutaneous Squamous Cell Carcinoma Arising from Chronic Hidradenitis Suppurativa: A Case Report of Treatment by Slow Mohs Micrographic Surgery

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory condition presenting with painful, deep-seated abscesses and sinus tracts in multifocal locations. Rarely, longstanding inflammation in HS may lead to serious complications, such as cutaneous squamous cell carcinoma (SCC) (also termed Marjolin ulcer). Herein, we report a case of invasive cutaneous SCC arising from chronic ulcers of a HS patient. A 40-year old Korean male, a current smoker with 20 pack-year history, presented with a history of painful, recurrent, deep-seated abscesses and ulcers on the buttocks since his late teens, thus classified as Hurley stage III. A large purulent ulcer developed on the right buttock several months ago. Initial treatment was focused on controlling infection and facilitating wound healing. The lesion showed 50% reduction of size in 6 weeks, but also developed foul odor and showed fungating margins. Multiple skin biopsies were consistent with invasive SCC. Magnetic resonance imaging revealed a few enlarged lymph nodes on the right inguinal area, which was confirmed as metastasis on frozen biopsy.Slow Mohs micrographic surgery and radical right inguinal lymph node dissection was done. Incidence rates of SCC aris-ing from HS have been reported up to 4.6%. To our knowledge, this is the first report of cutaneous SCC arising from HS in Korea. Our case emphasizes that the diagnosis of cutaneous SCC in HS should not be delayed, and early surgical intervention is crucial for better outcomes.

Effect of the Sodium-Glucose Cotransporter 2 Inhibitor, Dapagliflozin, on Genitourinary Infection in an Animal Model of Type 2 Diabetes / 대한배뇨장애요실금학회지

Purpose@#To investigate the effect of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on inflammatory cytokines of urogenital tissue in a rat model of type 2 diabetes (T2DM) to infer pharmaceutical influence of dapagliflozin on genitourinary infection or inflammation. @*Methods@#Study animals were divided into the following 4 groups of 10 animals each: (1) the Otsuka Long-Evans Tokushima Fatty (OLETF)-DA group treated with dapagliflozin at 1.0 mg/kg/day, (2) the OLETF-VO group treated with voglibose at 0.6 mg/kg/day, (3) the control group (OLETF-CO) given water, and (4) the Long-Evans Tokushima Otsuka (LETO) rats were included as nondiabetic control group. Changes in blood glucose, 24-hour urine volume, and urine glucose were measured. The interleukin-1β (IL-1β) and interleukin-18 (IL-18) levels in the bladder and the urethra were quantified, respectively. @*Results@#The urine glucose level and the 24-hour urine volume at 12 weeks of treatment were significantly higher in the OLETF-DA group than that in any other group (P<0.05). The cytokine analysis of the bladder and urethra showed higher IL18 and IL-1β in the OLETF-DA and the OLETF-CO groups than that in the OLETF-VO and LETO groups (P<0.05). The cytokine levels did not differ between the OLETF-DA and the OLETF-CO groups, and the level of IL-18 in the OLETF-DA group was higher in the urethra than in the bladder. @*Conclusions@#This study revealed that dapagliflozin increased the urine glucose concentration, resulting in an inflammatory response remain in the urogenital tract as the untreated diabetic rats. Therefore, when treating patients with T2DM with dapagliflozin, careful attention should be paid to genitourinary infection or inflammation.

What is the current status of sexually transmitted infections in the elderly?

Sexually transmitted infections (STIs) in the elderly are a social problem that can no longer be ignored due to rapid population aging and the growing proportion of elderly people who continue to engage in sexual activity. An accurate assessment of the current status of STIs in the elderly, as well as their sexual behavior, is a prerequisite for public STI prevention and education campaigns and for future studies on the subject. Numerous studies have found a growing incidence of STIs among the elderly population. In South Korea, a recent analysis of the Health Insurance Review & Assessment Service database between 2010 and 2016 showed that the prevalence of STIs was not high and that it had remained stable in recent years, implying that STIs are not currently a significant public health issue in South Korea, unlike in other countries. The reported proportion of sexually active elderly individuals was higher than expected (40% to 60%, for both sexes). The rate of condom use is generally very low among the elderly, usually because they are past their reproductive age. In a South Korean survey-based study, approximately 42% of elderly South Koreans were sexually active, and the rate of condom use was also very low (under 15%). Although STIs are not currently a significant public health issue in South Korea, several sexual health behaviors found in numerous studies, such as the very low rate of condom use, together with rapid population aging, call for ongoing monitoring of STIs in the elderly population.

What is the current status of sexually transmitted infections in the elderly?

Sexually transmitted infections (STIs) in the elderly are a social problem that can no longer be ignored due to rapid population aging and the growing proportion of elderly people who continue to engage in sexual activity. An accurate assessment of the current status of STIs in the elderly, as well as their sexual behavior, is a prerequisite for public STI prevention and education campaigns and for future studies on the subject. Numerous studies have found a growing incidence of STIs among the elderly population. In South Korea, a recent analysis of the Health Insurance Review & Assessment Service database between 2010 and 2016 showed that the prevalence of STIs was not high and that it had remained stable in recent years, implying that STIs are not currently a significant public health issue in South Korea, unlike in other countries. The reported proportion of sexually active elderly individuals was higher than expected (40% to 60%, for both sexes). The rate of condom use is generally very low among the elderly, usually because they are past their reproductive age. In a South Korean survey-based study, approximately 42% of elderly South Koreans were sexually active, and the rate of condom use was also very low (under 15%). Although STIs are not currently a significant public health issue in South Korea, several sexual health behaviors found in numerous studies, such as the very low rate of condom use, together with rapid population aging, call for ongoing monitoring of STIs in the elderly population.

History of Syphilis and Gonorrhea in Korea

In Korea, systematic management of sexually transmitted infections (STIs), including syphilis and gonorrhea, began only after the end of the Korean War. Since the enactment of the Law on Prevention of Communicable Diseases of 1954, STI has been managed and regularly monitored in high risk group. However, the major turning point was the implementation of the Special Law on Prostitution, which was enacted in September 2004. The national policy on STI management had also changed from management of core groups by mandatory to voluntary examinations and treatment of patients by health examinations. The national surveillance system for STI was introduced in 2000 by the revision of the Prevention of Communicable Diseases Act of 1999. The incidence of STI had increased in the 1960s, but began to decline at the 1970s. In the 21st century, the incidence of STI has been increasing again. Currently, more thorough methods of STI management are needed in Korea.

Comparative Study between High Dose Aspirin and Ibuprofen in the Treatment of Kawasaki Disease in the Acute Stage

OBJECTIVE: Reye's syndrome can be caused by high dose of aspirin which is for treatment of acute phase of Kawasaki disease. We evaluated the effectiveness of treatment and coronary complications of replacing high dose of aspirin with ibuprofen for children in acute phase of Kawasaki disease. METHODS: Children with Kawasaki disease (n=235) were admitted in the pediatric department from January 1, 2015 to December 31, 2017. Echocardiography and laboratory tests were performed during admission, and the children were followed-up at 6–8 weeks after the onset. We retrospectively analyzed their characteristics and clinical outcomes. RESULTS: The children were assigned to receive either high dose of aspirin with intravenous immunoglobulin (IVIG) (aspirin group) or ibuprofen with IVIG (ibuprofen group). A total of 119 and 116 children were included in the aspirin and ibuprofen groups. Total fever duration was 6.5±1.6 days in the aspirin group, and 6.5±1.7 days in the ibuprofen group (P=0.674). The number of resistance to initial treatments was 11 in the aspirin group and 11 in the ibuprofen group (P=0.571). There were 13 initial coronary complications in the aspirin group, and 10 in the ibuprofen group (P=0.552) and children who showed coronary artery abnormalities improvement at 6- to 8-week follow-up was seven and five in the aspirin and ibuprofen groups, respectively (P=0.769). CONCLUSION: We may consider using ibuprofen in acute phase of Kawasaki disease to prevent the severe complications of aspirin use, such as Reye's syndrome in the case concerning influenza or varicella.

Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review

Ecthyma gangrenosum (EG) is a rare skin manifestation which starts with a maculopapular eruption and followed by a necrotic ulcer covered with black eschar. EG usually occurs in immunosuppressed patients with Pseudomonas aeruginosa sepsis. We present a previously healthy 12-month-old girl with EG by P. aeruginosa and agranulocytosis due to influenza A and then rhinovirus infection, without bacteremia. It is important for allergists to culture wound and differentiate EG from other skin disorders including Tsutsugamushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.

Two Cases of Neonatal Lupus and Literature Review

Neonatal lupus is a rare rheumatic disease. Clinical manifestations include characteristic annular or macular rashes, congenital heart block, cytopenias, and hepatitis. Neonatal lupus is caused by transmission of maternal immunoglobulin G autoantibodies such as anti-SSA/Ro antibody or anti-SSB/La antibody to the fetus through the placenta. We report two cases of neonatal lupus. The first case refers to an 18-day-old male with annular rashes on both cheeks, neutropenia, positive tests for antinuclear antibody, anti-SSA/Ro antibody, and anti-SSB/La antibody. His mother was diagnosed with systemic lupus erythematosus characterized by positive tests for antinuclear antibody, anti-SSA/Ro antibody, and anti-SSB/La antibody. The second case represents a 32-day-old female with annular rash on both hands, soles, and the genital area, neutropenia, hepatitis, positive tests for antinuclear antibody, and anti-SSA/Ro antibody. Skin punch biopsy was conducted. Her mother did not have history of connective tissue diseases. We referred her mother to the division of rheumatology of the department of internal medicine. The mother was suspected with primary Sjögren's syndrome because of arthralgia and dry eye symptoms with positive tests for antinuclear antibody, anti-SSA/Ro antibody, anti-SSB/La antibody, and rheumatoid factor. It is necessary to suspect neonatal lupus in neonates or infants with characteristic annular rash with or without maternal history of connective tissue disorders.

Down syndrome with asymptomatic neuroglial cyst: A case report and review of the literature

Down syndrome (DS, trisomy 21) is associated with neuroanatomical abnormalities, including choroid plexus cysts and various types of brain tumors. Trisomy 21 is associated with oncogenic factor, especially in brain tumor. The brain of DS patients had a smaller volume of gray and white matter and an unbalanced cerebellum volume, indicating a smaller volume overall than normal. We report a case of a DS male patient who had an incidentally discovered neuroglial cyst in left cerebellar vermis. He visited our hospital with gait disturbance and fatigue. But, the neurologic exam was normal. To the best of our knowledge, this is the first reported case of a neuroglial cyst in a trisomy 21 patient. As the developmental mechanisms of a cyst and the choroid plexus are related, more research is needed.

Nasal Septal Swell Body: Radiologic Characteristics and the Relationship to Nasal Septal Deviation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To analyze the radiographic dimensions of the nasal septal swell body and to find a relationship between the septal body (SB) thickness and the degree of septal deviation. SUBJECTS AND METHOD: One hundred eighteen ostiomeatal units computed tomographic scans were reviewed retrospectively. Dimensions of the SB, distances to other landmarks and the degree of septal deviation were measured. RESULTS: The SB was 4.7 mm thick on the average, with the mean width of 11.4±1.7 mm, the height of 18.2±3.4 mm, and the length of 25.1±4.6 mm. The point of greatest prominence of SB was 23.7±2.7 mm from the nasal floor, which is 1.8±2.2 mm lower than the rhinion; it is also 5.0±2.6 mm anterior to the caudal end of the middle turbinate, and 4.5±2.8 mm posterior to the caudal end of the inferior turbinate. In 62 of the 78 cases with septal deviation, the SB was larger on the side opposite the deviation. The mean difference in the SB thickness of ipsilateral and contralateral to a septal deviation was 3.4 mm, 2.3 mm and 1.4 mm, for cases with severe, moderate and mild septal deviation, respectively. The difference in SB thickness was found to correlate with the degree of septal deviation. CONCLUSION: The SB is a structure of 11×18×25 mm in size, and like inferior turbinate, it is more prominent contralateral to a septal deviation. SB, situated in the nasal valve region, may have a role in regulating nasal airflow and may contribute to nasal obstruction.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

BACKGROUND: The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers. METHODS: Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (Anyplex™ II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France). RESULTS: The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9-58.9% and 9.1-25.0% of the three species were susceptible to these drugs, respectively. CONCLUSIONS: M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

Clinical Features of Varicose Vein in Pediatric Population / 소아외과

PURPOSE: Varicose veins requiring operative treatment have been more common recently, but there are not enough studies among children dermographics because most patients belong to the adult population. We concentrated on varicose vein of under 18 years old, and here intend to report cases of our clinical experiences. METHODS: From January 2003 until December 2014, there were 6 children under 18 years old who required varicose vein management. Data was collected by the investigation of medical records retrospectively, including preoperative symptoms, diagnostic tools, treatment methods, results of treatment, and complications. RESULTS: The mean age was 11 years (range, 3-17 years), and gender ratio was 1:2 (2 male, 4 female). The involved legs were on the right in 3 cases, on the left in 2 cases, and on both in 1 case. The most common symptoms were venous bulging and tortuosity in 6 cases, and other symptoms were Klippel-Trenaunay-Weber syndrome in 2 cases, pain and fatigue in 1 case, port-wine stain in 1 case, and telangiectasia in 1 case. Duplex sonography was performed to confirm venous reflux in all cases. The additional venography was performed to check for anatomical variation in 1 case, and three-dimensional CT in 2 cases. Treatments were high ligation and stripping in 3 cases, and endovenous laser therapy in 3 cases. Additionally, remnant varicosities after first operations were treated by endovenous laser therapy in all cases. During the mean postoperative follow-up period of 60 months, complications included edema of the foot and petechia in 2 cases each, and were not severe. CONCLUSION: Operative treatments including high ligation and stripping, and endovenous laser therapy are very effective for the management of varicose vein in the pediatric population, with improvements in quality of life including relief of symptoms and management of the cosmetic aspect.

The Relationship of the Medial Maxillary Sinus Roof to the Sphenoid and Posterior Ethmoid Sinuses in Korean: A Radiologic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to perform radiologic study assessing the utility of the medial maxillary sinus roof (MMSR) as a reference point for providing a safe route of entry into the sphenoid and the posterior ethmoid sinuses in Korean patients. SUBJECTS AND METHOD: We retrospectively reviewed 82 consecutive ostiomeatal computed tomographic scans of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest MMSR, natural sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base were measured. Then the vertical distances from the highest MMSR to the sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base were calculated. The maxillary sinus to posterior ethmoid height ratio was calculated. RESULTS: The average height of the highest MMSR relative to the nasal floor was measured to be 33.95+/-3.36 mm. The vertical distance from the highest MMSR to the natural sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base was 1.87+/-3.52 mm, 11.77+/-3.30 mm, 6.09+/-3.16 mm, and 15.46+/-3.07 mm respectively. The mean ratio of the maxillary sinus to the posterior ethmoid height was 2.3+/-0.56. CONCLUSION: The MMSR can be used as a reliable landmark to localize the natural sphenoid ostium and to enable a safe entry into the posterior ethmoid. Moreover, it provides a reasonable margin of safety from the skull base.