We report two human cases of tick bite. A 63-year-old male had a pruritic pea-sized brownish nodule on the left popliteal area. Another 41-year-old male had an asymptomatic bean-sized black nodule in the pubic area. The ticks were identified as Ixodes nipponensis, which are the 18th and the 19th cases in Korea.
Adult ; Animals ; Bites and Stings/*parasitology/pathology ; Human ; *Ixodes/anatomy & histology ; Male ; Middle Aged ; Skin/*parasitology/pathology ; Tick Infestations/*parasitology/pathology

BACKGROUND AND OBJECTIVES: After bilateral mastoidectomy, taste change is common because of injury to chorda tympani nerve. We aimed to understand about the appropriate interval of sequential bilateral mastoidectomy. SUBJECTS AND METHOD: Retrospective review was carried out for 25 patients who underwent sequential bilateral mastoidectomy from March 2004 to November 2011. RESULTS: Among the 25 patients, there were 19 patients whose chorda tympani nerve was injured after bilateral mastoidectomy, and eight of those 19 patients complained of taste disturbance. The rates of dysfunction according to operation interval were within 6 month (55%, 5/9), between 6 and 12 months (33%, 2/6), and above 12 months (10%, 1/10). Compared to canal wall up mastoidectomy, for canal wall down mastoidectomy, taste disturbance was more common (p=0.001). CONCLUSION: The result supports that at least 6 months interoperative period for bilateral chronic otitis media may be needed to avoid taste disturbance. A further large study may validate this result.
Chorda Tympani Nerve ; Dysgeusia ; Humans ; Otitis Media ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Ocular torsion may be a result of vestibulopathy. The funduscopy is the most reliable method of measuring an ocular torsion. However, the reference value of ocular torsion in Korean is available at only limited ages. Therefore, we analyzed the angle of ocular torsion more age-specific than previous study. MATERIALS AND METHODS: We used the fundus photograph of health check-up visitor. And age and sex specific average angle of ocular torsion was measured. RESULTS: The right and left average angle of ocular torsion were 7.7+/-3.6degrees, 5.3+/-3.0degrees, respectively. In addition, there was no significant difference in age or sex specific angle of ocular torsion. CONCLUSION: This result might give an aid to evaluating the function of otolithic organ by measurement of ocular torsion.
Ophthalmoscopes ; Otolithic Membrane ; Reference Values ; Reflex, Vestibulo-Ocular

A 80-year-old man presented with recently aggravated dizziness. He has taken an anti-Parkinson drug before 2 years ago. Left spontaneous down beating nystagmus was observed, also ataxic gait. Brain MRI showed diffuse brain atrophy, otherwise no abnormal finding. Rotation chair test showed decreased gain, phase lead and no asymmetry. Saccadic test showed delayed latency and decreased accuracy. And Calroic test didn't show no canal paresis. Dizziness due to Parkinsonism has been known relatively common, especially in old age. However, it is often difficult to diagnosis a Parkinson disease when old age patient present with dizziness. Hence, we report a case of old aged Parkinsonism patient who presented with acute dizziness in perspective of diagnostic careful point with literature review.
Aged ; Aged, 80 and over ; Atrophy ; Brain ; Dizziness ; Eye Movements ; Gait ; Humans ; Paresis ; Parkinson Disease ; Parkinsonian Disorders ; Saccades

BACKGROUND AND OBJECTIVES: Although the standard management of an abdominal aortic aneurysm (AAA) is surgery, endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes for the endovascular treatment of AAA. SUBJECTS AND METHODS: Between November 1996 and August 2004, 59 patients with an AAA (53 males, mean age 68.0+/-9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and at followed up with computed tomography (CT) at 1, 3, 6 and 12 months, and yearly thereafter. RESULTS: Technical success was achieved in 54 of the 59 patients (91.5%). The periprocedural mortality rate was 3.4% (2 of the 59 patients). A primary endoleak was found in 12 patients (20.3%)(type I; 9 patients, type II; 2 patients, type III; 1 patient), 2 of which required subsequent surgical conversion. Spontaneous resolution of an endoleak was seen in 4 patients (33.3%). The average follow-up period of 57 patients was 27.5 months (range from 72 days to 2581 days). In 8 patients (14.0%), a newly developed secondary endoleak was documented. A total 14 patients (23.7%) died during the follow-up period (rupture; 3, operation-related sepsis; 3, unrelated causes; 3, cardiac arrest; 1, unknown causes; 4). The cumulative survival rates at 30 days and at 1 and 2 years were found to be 93.0, and 85.7 and 76.3%, respectively, using Kaplan-Meier methods. Secondary intervention was required in 12 patients (21.8%), and surgical conversion in 4 (6.8%), with 2 (3.4%) requiring conversion to open surgery immediately after the intervention. In those with technical success, without endoleaks and graft failure, the survival rate during follow-up was higher (97.1%; rate with the exception of unrelated cause of death) than that of all the patients. CONCLUSION: The immediate and mid-term results suggest that the endovascular treatment of an AAA is technically feasible and effective. There was higher mortality and morbidity in primary and newly developed endoleak cases; therefore, proper selection of cases, according to the anatomical and clinical criteria, is essential, with meticulous regular follow-ups being critical for the optimal endovascular treatment of an AAA.
Angiography ; Aortic Aneurysm, Abdominal* ; Conversion to Open Surgery ; Endoleak ; Follow-Up Studies ; Heart Arrest ; Humans ; Male ; Mortality ; Sepsis ; Survival Rate ; Transplants ; Treatment Outcome

BACKGROUND: Gamma-glutamyltransferase (GGT), which is an intracellular antioxidant due to maintain intracellular concentrations of glutathione, may be a marker of oxidative stress. In the present study, oxidative stress was thought to be a cause of diabetes mellitus. So, We performed a cross sectional study about the relations between GGT and prevalence of diabetes mellitus. METHODS: In total 5049 healthy men who had visited the Yonsei Wonju Christian Hospital for health care from 1st January 2002 to 31st December 2002, we measured BMI, blood pressure, GGT, total cholesterol, ALT and fasting blood sugar levels. RESULTS: There were strong relations between serum GGT concentrations and age, BMI, total cholesterol, systolic blood pressure, diastolic blood pressure and ALT level. GGT level had positive correlations with the prevalence of diabetes mellitus and impaired glucose tolerance when divided into four classes, 0~19 IU/L, 20~39 IU/L, 40~59 IU/L and over 60 IU/L. We got the same results after adjustment with BMI, total cholesterol, blood pressure and ALT level. CONCLUSION: There was a positive correlation between GGT level and the prevalence of diabetes mellitus, and that was definite especially when BMI, total cholesterol, blood pressure and ALT levels were in normal range. We suggest that serum GGT level would be an important marker in the development of diabetes mellitus.
Blood Glucose ; Blood Pressure ; Cholesterol ; Delivery of Health Care ; Diabetes Mellitus* ; Fasting ; gamma-Glutamyltransferase* ; Gangwon-do ; Glucose ; Glutathione ; Humans ; Male ; Oxidative Stress ; Prevalence* ; Reference Values

BACKGROUND AND OBJECTIVE: Although the endovascular method of treating abdominal aortic aneurysms (AAA) shows good early results and benefits, the late outcome of this treatment remains uncertain. This study evaluated the late outcome following an endovascular AAA repair. SUBJECTS AND METHODS: Thirty-three patients that had undergone an endovascular AAA repair at our institute were evaluated. The results of the treatment were evaluated by an angiography, taken just after the completion of the procedure, and by contrast-enhanced CT scans at 1, 3, 6 and 12 months, and annually thereafter. RESULTS: The patient's characteristics were as follows: 29 (88%) were male, 19 (58%) had coronary artery disease and 7 (21%) had renal insufficiency. A technical success was achieved in 31 patients (94%), with primary endoleaks in two. Two patients (6.1%) died within 1 month of the procedure, both at an elderly age, with high risk. There was 1 (3%) incidence of early complications that required treatment. During the 28 month follow-up period, 6 patients (20%) needed a secondary procedure. Endoleaks remained in 4 patients, and the size of aneurysm increased in 3 patients. Four patients died during follow-up, and two had an endoleak. The cause of death was not related to cardiovascular diseases in the other two patients. The event free survival at 24 months was 72%. CONCLUSION: The late outcome after an endovascular AAA repair was favorable. However, a secondary procedure was needed, and endoleaks observed, in half of the patients that died during follow-up. Therefore, regular evaluation of aneurysms and the management of endoleaks are very important for a favorable late outcome in endovascular AAA repair patients.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Cardiovascular Diseases ; Cause of Death ; Coronary Artery Disease ; Disease-Free Survival ; Endoleak ; Follow-Up Studies ; Humans ; Incidence ; Male ; Renal Insufficiency ; Tomography, X-Ray Computed

PURPOSE: To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography. MATERIALS AND METHODS: This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate <60 mL/min. Nicorandil 12 mg dissolved in 100 mL of 0.9% saline was administered intravenously for 30 minutes just prior to coronary angiography in the nicorandil group. The same volume of only saline was given to the control group. The primary end-point was the incidence of CIN, defined as >0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline. RESULTS: The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6+/-69.1 mL vs. 126.9+/-74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58+/-24.07% vs. 0.96+/-17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01+/-0.43 mg/mL vs. 0.02+/-0.31 mg/mL, p=0.005). CONCLUSION: Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.
Administration, Intravenous ; Aged ; Contrast Media/*adverse effects ; Coronary Angiography/*adverse effects/methods ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Diseases/*chemically induced/epidemiology/physiopathology/*prevention & control ; Male ; Middle Aged ; Nicorandil/*administration & dosage/therapeutic use

Contrast-enhanced multi-detector row spiral computed tomography (MDCT) was introduced as a promising noninvasive method for vascular imaging. This study examined the accuracy of this technique for detecting significant coronary artery stenoses. Both MDCT (Sensation 16, Siemens, Germany, 12 x 0.75 mm collimation and 0.42 sec rotation speed, 120 kV, 500 effective mA, and 2.7 mm/rotation table-feed) and invasive coronary angiography (CAG) were performed on 61 patients (mean age 59.2 +/- 10, 44 men) who were suspected of having coronary artery disease. All patients were treated with atenolol (25 - 50 mg) prior to imaging and the heart rate was maintained below 65 beats per minutes during image acquisition. The images were reconstructed in the diastole around TI - 400 ms with a 0.5 mm increment and a 1.0 mm thickness. All coronary arteries with a diameter of 2.0 mm or more were assessed for the presence of a stenosis (> 50% luminal narrowing). Two independent radiologists who were unaware of the results of the invasive CAG evaluated the MDCT data, and the results were compared with those from the invasive CAG (interval 1- 27, mean 11 days). An evaluation of the CT coronary angiogram (CTCA) was possible in 58 of the 61 patients (95%). Image acquisition of the major coronary arteries including the left main trunk was available in 229 out of 244 arteries. Invasive CAG showed that 35 out of 58 patients had significant coronary artery stenoses by. patient analysis of those who could be evaluated showed that CT coronary angiography correctly classified 30 out of 35 patients as having at least 1 coronary stenosis (sensitivity 85.7%, specificity 91.3%, positive predictive value 93.8%, negative predictive value 80.8%). By analyzing each coronary artery, CAG found 62 stenotic coronary arteries in the 229 coronary arteries that could be evaluated. MDCT correctly detected 50 out of 62 stenotic coronary arteries and an absence of stenosis was correctly identified in 156 out of 167 normal coronary arteries (sensitivity 80.6%, specificity 93.4%, positive predictive value 81.9%, negative predictive value 92.8%). The non-invasive technique of MDCT for examining the coronary artery appears to be a useful method for detecting coronary artery stenoses with a high accuracy particularly with the proximal portion and large arteries.
Aged ; Coronary Stenosis/*radiography ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Reproducibility of Results ; Sensitivity and Specificity ; *Tomography, Spiral Computed/standards

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation