Cluster headache is a unique primary headache disorder characterized by unilateral severe orbital pain with ipsilateral autonomic symptoms. Symptomatic cluster headache can be caused by variable diseases, such as cerebral aneurysm, arteriovenous malformation, cerebral venous thrombosis, carotid dissection, pituitary tumor, and meningioma. We report a 33-year-old woman with parasellar meningioma mimicking cluster headache. After Novalis stereotactic radiosurgery, pain attacks disappeared.
Adult ; Cluster Headache* ; Female ; Headache Disorders, Primary ; Humans ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations ; Meningioma* ; Orbit ; Pituitary Neoplasms ; Radiosurgery* ; Venous Thrombosis

The Kallmanns syndrome is the most common form of isolated hypogonadotropic hypogonadism in which anosmia or hyposmia resulting from agenesis of hypoplasia of the olfactory lobes is associated with LHRH deficiency, This syndrome is genetically heterogeneous and can be trans-mitted as an X-linked, autosomal dominant or autosomal recessive trait. The hypogonadotropic hypogonadism results in absent or incomplete pubertal development and may be associated with anosmia or hyposmia, mid-line defect(color blindness, cleft-lip or
Blindness ; Cryptorchidism ; Epiphyses ; Femur Neck ; Gonadotropin-Releasing Hormone ; Growth Plate ; Head ; Humans ; Hypogonadism ; Kallmann Syndrome ; Male ; Olfaction Disorders ; Olfactory Cortex ; Slipped Capital Femoral Epiphyses

Although obturator herniae are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. The preoperative diagnosis is difficult because of nonspecific symptoms and sign. They often produce a small bowel obstruction. The treatment is always surgical. Several repair techniques have been described: a sac ligation alone, a direct suture repair, and the use of autologous tissue or prosthetic repair. Recently, the placement of permanent mesh prostheses, in a clean contaminated operative field, has been performed due to the minimal wound-related morbidity and patient mortality. Thus, utilization of a permanent mesh in an obturator hernia is a new, simple and effective method for repair. Two cases of a strangulated obturator hernia were experienced in elderly women. The peritoneal cavity was not overly contaminated, with only necrotic foci on the herniated small bowel wall noted. A segmental resection of the small bowel was performed. Consequently, the hernia defect was closed with mesh- plug between the peritoneum and periosteum of the obturator foramen. Here, two cases of obturator herniae treated by use of a mesh-plug are reported, with a brief review of the literature.
Aged ; Diagnosis ; Female ; Hernia ; Hernia, Obturator* ; Humans ; Ligation ; Mortality ; Periosteum ; Peritoneal Cavity ; Peritoneum ; Prostheses and Implants ; Sutures

PURPOSE: This study aimed to examine levels of stress and professionalism of nurses who provided nursing care during the 2015 Middle East respiratory syndrome outbreak based on their experience, to investigate the nurses' intention to respond to possible future outbreaks in relation to their experience during the outbreak, and to determine the relationship between the outbreak experience and nursing intention considering stress and professionalism. METHODS: A self-administered questionnairewas designed based on modifications of related questionnaires, and used to assess levels of stress, professionalism, and nursing intention according to participants' experiences during the outbreak. Multiple regression analysiswas used to examine the relationship between the outbreak nursing experience and nursing intention considering stress and nursing professionalism. RESULTS: The overall stress, professionalism, and nursing intention scores for the firsthand experience group were 33.72, 103.00, and 16.92, respectively, whereas those of the secondhand experience group were 32.25, 98.99, and 15.60, respectively. There were significant differences in professionalism and nursing intention scores between the groups (p = .001 and p < .001, respectively). The regression analysis revealed that the regression estimate between stress and nursing intention was B(SE) = −0.08(0.02), beta = −0.21, p < .001 and the regression estimate between professionalism in nursing and nursing intention was B(SE) = 0.05(0.01), beta = 0.23, p < .001. CONCLUSIONS: Prior outbreak nursing experience was importantly associated with intention to provide care for patients with a newly emerging infectious disease in the future considering stress and professionalism. Gathering information about nurses' experience of epidemics and regular assessment of job stress and professionalism are required.
Communicable Diseases* ; Communicable Diseases, Emerging ; Coronavirus ; Coronavirus Infections ; Disease Outbreaks ; Emergencies* ; Hospitals, Public* ; Humans ; Intention* ; Korea* ; Nursing Care ; Nursing* ; Professionalism* ; Stress, Psychological

DiGeorge syndrome is the developmental anomalies of the third and fourth pharngeal pouches. Recently, damages or abnormal development of the neural crest is suggested as a possible pathogenetic factor, because neural crest cells play a crucial role in development of pharyngeal pouch derivatives, e.g. thymus and parathyroid glands, as well as the aortic arches and conotruncal part of the heat. Most cases have abnormal findings of chromosome 22 and are sporadic, but familial cases have been described. Typical features of DiGeorge syndrome are congenital heart disease, aplasia or hypoplasia of the thymus and parathyroid glands and facial dysmorphism. The main problems and cause of death are severe congestive heart failure due to cardiac anomlies, hypocalcemic complications or immunocompromised conditions. As these results, most cases were expired at infantal period or early childhood. Recently, we have a case of Digeorge syndrome which was associated with complex cardiovascular anomalies(tetralogy of Fallot, atrial septal defect, right aortic arch, left hemitruncus), severe hypocalcemia, aplasia of thymus and facial dysmorphism.
Aorta, Thoracic ; Cause of Death ; Chromosomes, Human, Pair 22 ; DiGeorge Syndrome* ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Atrial ; Hot Temperature ; Humans ; Hypocalcemia ; Infant ; Neural Crest ; Parathyroid Glands ; Thymus Gland

BACKGROUND/AIMS: It have been reported that operative mortality and morbidity rate rise significantly when emergency cholecystectomy is performed in critically ill patients with acute cholecystitis(AC), and many studies have also concluded that delayed or interval laparoscopic cholecystectomy(LC) in patients with AC demonstrated high conversion rate and complication rate compared with early LC. However, if the acutely inflamed gallbladder(GB) is decompressed by emergent percutaneous gallbladder drainage(PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC or may decrease the wound complication of delayed open cholecystectomy, when the patient is in better condition. The purpose of this retrospective study was to assess the outcome of delayed cholecystectomy focused on LC following PGBD in patients with AC METHODS: A total of 181 patients with AC were divided into PGBD(n= 66) and non-PGBD group(n= 115), and each group were subdivided into PGBD-delayed LC(after 72 hours of admission, n= 32), PGBD-open cholecystectomy(n= 20), non-PGBD-early LC(within 72 hours of admission, n= 40), non- PGBD-delayed LC(n= 17), non PGBD-open cholecystectomy group(n= 58) and others. PGBD group had higher incidence of comorbidity compared with non-PGBD group. Outcomes of cholecystectomy was assessed by conversion rate and morbidity rate(chi2 test), LC time and hospital stay(median test) for LC, and morbidity for open cholecystectomy in PGBD group compared with those of non PGBD group. RESULTS: PGBD promptly relieved of symptom of AC in 94 % of patients and showed 3 % of technical failure and 4.5 % of complication rate. Compared with non PGBD-early and delayed LC group, the PGBD-delayed LC group showed longer LC time(median 110 min vs 82.5, p < 0.05, vs 95 min), a little lower conversion rate(12.5 % vs 22.5 % vs 17.6 %), similar morbidity rate(19% vs 17.5 % vs 29 %) and prolonged total hospital stay(median 12.5 days vs 7 days, p < 0.001, vs 10 days). In open cholecystectomy series, PGBD group showed lower morbidity rate compared with non PGBD group(5% vs 24 %, p < 0.05) CONCLUSION: Unlike to open cholecystectomy series, PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with non PGBD. Thus we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk group such as elderly or critically ill patients and to acalculous cholecystitis.
Acalculous Cholecystitis ; Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Comorbidity ; Critical Illness ; Drainage* ; Emergencies ; Gallbladder* ; Humans ; Incidence ; Length of Stay ; Mortality ; Retrospective Studies ; Wounds and Injuries

PURPOSE: This study was to identify the effectiveness of high-intensity laser therapy on pain and function of a frozen shoulder. METHODS: Thirty patients were assigned to two groups: the experimental group (n=15) and the control group (n=15). Both groups received traditional therapy for 4 weeks, 3 days a week. The experimental group, however, received an additional high intensity laser therapy. Pain was measured using the visual analogue scale (VAS). The functional ability was measured using the patient specific functional scale (PSFS). A paired t-test was used to determine any differences before and after the treatment, and an independent t-test was used to determine any differences between treatment groups. RESULTS: Both groups showed a statistically significant difference for VAS and PSFS score (p<0.05). In comparison between two groups, more experimental group than control group statistically significant difference (p<0.05). CONCLUSION: There seems to be a positive effect on pain and function of frozen shoulder from using high intensity laser therapy.
Bursitis* ; Humans ; Laser Therapy*

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Displacement (Psychology) ; Hand ; Humans ; Median Nerve ; Radius ; Sensitivity and Specificity

It is well known that obesity central obesity is associated with insulin resistance and some studies reported that sex hormones were associated with insulin resistance. Recently, low levels of sex-hormone binding globulin(SHBG), an indirect index of androgenicity, have been observed to predict the development of non-insulin dependent diabetes mellitus(NIDDM) in women and SHBG has been proposed as a marker for insulin resistance. In contrast to findings in women, decreased SHBG did not predict the occurrence of NIDDM in men, so it is suggested that sex hormones may have a different role for insulin resistance between men and women. To investigate the difference of the associations among the body fat distribution, sex hormone and insulin sensitivity index in men and women, we measured body-mass index(BMI) and waist to hip circumference ratio(WHR) and concentrations serum SHBG, total testosterone, free testosterone, and dehydroepiandrosterone sulfate(DHEA-S) concentrations in 29 healthy adults(men:19, women:10) who showed normal glucose tolerance. Insulin sensitivity index(M/I) was measured by euglycemic hyperinsulinemic clamp. There were no differences in age, BMI, fasting plasma glucose, insulin and free fatty acid levels between men and women. WHR of men is higher than that of women(0.82+-0.01 vs. 0.73+-0.01, p=0.002). Insulin sensitivity index(M/I) is similar in men and women(7.80+-0.71 mg/kg/min/uU/ml X 100 vs. 9.74+-0.89 mg/kg/min/uU/ml X 100, p=0.196).In Pearson's correlation, M/I was significantly correlated with BMI(r=-0.69, p<0.01) and WHR(r=-0.68, p<0.01) in men and DHEA-S(r=-0.68, p<0.05) and SHBG(r=0.61, p=0.056) concentrations in women.In multiple regression analysis, M/I had the most significant association with BMI(R^2=0.484, beta=-0.696, p<0.001) in men and DHEA-S(R^2=0.471, beta=-0.686, p<0.05) concentration in women.Conclusively, we found that sex hormones were significantly associated with insulin resistance and the effects of sex hormones on insulin resistance may be different in men and women.
Adipose Tissue ; Blood Glucose ; Body Fat Distribution ; Body Mass Index ; Dehydroepiandrosterone ; Dehydroepiandrosterone Sulfate ; Diabetes Mellitus, Type 2 ; Fasting ; Female ; Glucose ; Gonadal Steroid Hormones ; Hip ; Humans ; Insulin Resistance ; Insulin ; Male ; Multiple Endocrine Neoplasia Type 1 ; Obesity ; Obesity, Abdominal ; Testosterone

This study utilized the Community Multiscale Air Quality model to simulate the spatial distribution of benzene, toluene, and xylene (BTX) concentrations from large national industrial complexes (IC) located in the Ulsan metropolitan region (UMR). Through controlling pollutant emissions from major IC, this study performed a quantitative analysis of the influence of pollutant emissions on BTX concentrations in surrounding urban areas. The results showed that approximately 40% of the annual average BTX concentrations in nearby urban grids were directly influenced by pollutant emissions from the IC. Seasonal modeling results indicated that average BTX concentrations were high around petrochemical complexes, with higher concentrations in the surrounding urban areas during the summer (July). All three of the BTX pollutants showed similar seasonal differences. Daily contributions differed significantly throughout the modeling period, with some values reaching a maximum of 80% during July. Overall, when urban areas were located downwind of the IC, contributions rose. Moreover, this study compared the differences in BTX contributions at each measurement point within the IC and urban areas, which showed that the influence of the IC emissions decreased significantly with distance. The spatial distribution and direct influence of the IC on BTX concentrations in the UMR identified through this study could be used to provide input data in environmental epidemiological studies.
Benzene ; Epidemiologic Studies ; Seasons ; Toluene ; Ulsan ; Xylenes