Otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss, are known to be related to temporomandibular disorders (TMDs). There have been several hypotheses regarding the clinical correlation between otologic complaints and TMDs, based on clinical phenomena with corresponding symptoms, the close neurological relationship between otic and masticatory structures, and anatomical features of the tympanic cavity and jaw joint. Function of the tensor tympani muscle seems to be crucial to understanding TMD-related otologic symptoms. The tensor tympani inserts into the handle of the malleus and it modulates sound transduction in situations of excessive noise. This muscle is innervated by the trigeminal nerve, like the masticatory muscles. Voluntary eardrum movement by pathological tensor tympani contraction results in various otologic symptoms. Thus, co-contraction of the tensor tympani with the masticatory muscle could be a possible cause of TMD-related otologic symptoms. The tensor tympani is rather unrelated to the acoustic reflex, in which the stapedius is strongly involved. The tensor tympani seem to be controlled by proprioceptive information from the trigeminal sensory nucleus. The peripheral innervation pattern of the tensor tympani and masticatory muscles is also supposed to be interconnected. The middle ear structure, including the malleus, incus, and tensor tympani, of mammals had been adapted for acoustic function and lacks the masticatory role seen in non-mammalian jawed vertebrates. The tensor tympani in non-mammals is one of the masticatory muscles and plays a role in the modulation of sound transduction and mastication. After the functional differentiation of the mammalian middle ear, the nervous connection of the tensor tympani with other masticatory apparatus still remains. Through this oto-stomatognathic vestige, the tensor tympani seems to contract unnecessarily in some pathological conditions of the TMD in which the masticatory muscles contract excessively. We hypothesized that the phylogenic relationship between the tensor tympani and masticatory apparatus is a significant and logical reason for TMD-related otologic complaints.
Acoustics ; Ear, Middle ; Earache ; Hearing Loss ; Incus ; Jaw* ; Joints ; Logic ; Malleus ; Mammals ; Mastication ; Masticatory Muscles ; Noise ; Reflex, Acoustic ; Stapedius ; Temporomandibular Joint Disorders ; Tensor Tympani* ; Tinnitus ; Trigeminal Nerve ; Tympanic Membrane ; Vertebrates ; Vertigo

There have been limited reports about the prevalence and its characteristics of glaucoma in Korea. To clarify further, we retrospectively analyzed the data of 1482 patients with glaucoma from January 1993 to December 1994. The prevalence of glaucoma was 0.58%. The type of glaucoma consisted of secondary glaucoma 33.9%, primary open angle glaucoma(POAG) in 33.2%, angle closure glaucoma(ACG) 28.0%, normal tension glaucoma 4.0% and congenital glaucoma 0.9%. The mean age of the patients with POAG was 55.2+/-16.5 and that of ACG was 64.7+/-9.2. In POAG, the age group over 40 years old occupied 79.7% while 99.3% was the age group over 40 years in ACG. The incidence rate of men was higher than women in POAG but in women it was 3.6 times higher than men in ACG. Secondary glaucomas due to diseases of uveal tract, neovascular glaucoma, steroid induced glaucoma, and aphakic (or pseudophakic) glaucoma were 37.0%, 18.9%, 16.5%, and 15.7% respectively.
Adult ; Female ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Neovascular ; Humans ; Incidence ; Korea ; Low Tension Glaucoma ; Male ; Prevalence ; Retrospective Studies

OBJECTIVES: We performed anterior spinal fusion and instrumentation in treatment of spinal tuberculosis. The clinical results of this operation and metal-related complications were evaluated to determine the rationale of anterior instrumentation in active tuberculous lesion. METHODS: From July 1989 to February 1993, we treated twenty-one patients with spinal tuberculosis by radical resection of the tuberculous lesion and bone grafting, followed by anterior instrumentation using Zielke rod system. The changes in spinal deformity were measured from lateral spinal radiographs obtained preoperatively and postoperatively at 3 months, 6 months, 1 year, 2 years and final follow-up. The recurrence of infection and possible complications were also observed clinically and radiologically. RESULTS: The mean kyphotic angle was decreased preoperatively from 21 degrees to 16 degrees at final follow-up in patients with thoracolumbar tuberculous lesions. The mean deformity angle was corrected 7 degrees in thoracolumbar tuberculosis and 12 degrees in lumbar tuberculosis compared with the preoperative deformity angle. There was not any persistence or recurrence of infection possibly related to the instrumentation. All patients were allowed early ambulation with the aid of a light brace. CONCLUSION: The clinical and radiological results suggested that the anterior instrumentation seemed to be one of the rational approaches for providing immediate stability in treating severe spinal tuberculosis without any significant risk of persistence or recurrence of infection.
Bone Transplantation ; Braces ; Congenital Abnormalities ; Early Ambulation ; Follow-Up Studies ; Humans ; Recurrence ; Spinal Fusion ; Tuberculosis ; Tuberculosis, Spinal*

Myopericarditis is an uncommon manifestation, but can be reaely a lethal complication of infectious mononucleosis. We experienced a case of infectious mononucleosis complicated by myopericarditis in which the clinical pictur was confused as acute myocarddial infarction. A 25-year-old male who presented with syncope and chest pain. The diagnosis of infectious mononucleosis was comfirmed by both a positive heterophil antibody test and a high titer of Epstein-Barr virus antibody. He was found to have completely normal findings at cardiac catheterization, including coronary arteriography. Pathologic specimen from right ventricular endomyocardial biopsy demonstrated extensive lymphocytic and eosinophilic infiltration of the myocardium.
Adult ; Angiography ; Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Diagnosis ; Eosinophils ; Herpesvirus 4, Human ; Humans ; Infarction ; Infectious Mononucleosis* ; Male ; Myocardium ; Syncope

No abstract available.
Humans ; Staphylococcal Infections*

PURPOSE: To evaluate the effects of transient prone position on vault and anterior chamber angle parameters in ICL implanted patients. METHODS: 40 eyes of 20 ICL implanted patients with at least 1 month of follow-up were included in the present study. The central ICL vault and anterior chamber parameters including angle opening distance at 500 (AOD500) were measured with the Visante anterior segment optical coherence tomography (OCT) (Carl Zeiss, Dublin, CA) in both the sitting and prone positions by tilting the OCT 90 degrees in the vertical axis and having the patient fixate downwards towards the floor. RESULTS: The mean central vault was 0.55 +/- 0.21 mm (SD) and 0.59 +/- 0.21 mm (SD) in the sitting and prone positions, respectively (p < 0.0001). The nasal and temporal AOD500 were 0.26 +/- 0.11 mm and 0.28 +/- 0.08 mm, respectively in the sitting position, which decreased to 0.24 +/- 0.10 mm and 0.26 +/- 0.08 mm in the prone position, however, both were not statistically significant (p = 0.08, p = 0.09). AOD500 was inversely correlated with vault (r = -0.47; p = 0.0024). There were no significant correlations between increase of vault and anterior chamber depth or white to white nor ICL vault. CONCLUSIONS: Transient prone positioning of ICL implanted patients can induce a significant increase in ICL vault.
Anterior Chamber ; Axis, Cervical Vertebra ; Eye ; Follow-Up Studies ; Humans ; Phakic Intraocular Lenses ; Prone Position ; Tomography, Optical Coherence

The authors performed prospectively the transcranial Doppler monitoring of middle cerebral arteries in 37 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who had clinical Grades of 1, 2, or 3, and were operated within 4 days after bleeding. There were several sonographic risk factors of developing delayed ischemic deficits; 1) An early steep increase of flow velocity exceeding 120 cm/sec. 2) An increase of maximum flow velocity more than 140 cm/sec. 3) The flow velocity increasing simultaneously with the onset of delayed ischemic deficit in which case preventive treatment was impossible. 4) Prolonged elevation of flow velocity for more than 7 days despite of aggressive treatment. It seemed to be mandatory to start preventive and aggressive treatment for the asymptomatic patients who showed higher flow velocity than 140 cm/sec. Transcranial Doppler sonography has another potential on deciding the timing of surgery.
Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Risk Factors ; Ultrasonography ; Ultrasonography, Doppler, Transcranial

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Aged ; Clinical Coding ; Critical Care* ; Diffusion ; Disease Outbreaks ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Hand ; Humans ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Male ; Methods ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Sputum

OBJECTIVE: Increasingly it is being recognized that genetic factors play a significant role in causing malformation. There are many available prenatal diagnostic methods including cytogenetic karyotyping using amniocentesis and cordocentesis, fluorescence in situ hybridization(FISH), and primed in situ labelling(PRINS). Our purpose was to attempt to discuss the clinical use of cytogenetic karyotyping, FISH, and PRINS. METHODS: We conducted 222 cases of cytogenetic karyotyping using amniocentesis and cordocentesis, l0 cases of FISH, and 10 cases of PRINS from January 1996 to July 1998 at Ewha Womans University Mokdong Hospital. Age distribution, chromosomal abnormalities by age group, indication, karyotype, and baby outcomes were performed. RESULTS: Overall incidence of chromosomal abnormalities was 7.7%(17cases) and chromosomal abnormalities were most frequently noted in 30-34 year old women and 35-39 year old women(2.3%, respectively). Among 222 cases, 25-29 year old women were highest(30.2%). Chromosomal abnormalities among cytogenetic karyotyping cases were Down syndrome, Edward syndrome, Patau syndrome, Deletion(8), Inversion(9), etc. The 5 cases of healthy baby among chromosomal abnormalities were delevered. Among 213 cases of karyotyping using amniocentesis, abnormal karyotyping cases were 15 cases. Among 15 cases, 8 cases were terminated and 5 cases of healthy baby were delivered. Among 9 cases of karyotyping using cordocentesis, 2 cases of chromosomal abnormalities(Edward, Down syndrome) were found and 3 cases healthy baby were delivered. Among 10 cases of FISH results, 6 case of FISH results were the same with G-banding and were different from G-banding. Among 10 cases of PRINS results, we got the PRINS results from 7 cases. CONCLUSION: It is concluded that cytogenetic karyotyping, FISH, and PRINS are very useful to detect chromosomal abnormalities.
Age Distribution ; Amniocentesis ; Chromosome Aberrations ; Cordocentesis ; Cytogenetics* ; Down Syndrome ; Female ; Fluorescence* ; Humans ; In Situ Hybridization* ; Incidence ; Karyotype ; Karyotyping* ; Prenatal Diagnosis* ; Primed In Situ Labeling

High frequency jet ventilation(HFJV) induces adequate gas exchange with tidal volume smaller than that of other conventional ventilation method. In critically ill patients, HFJV reduces the unwanted hemodynamic effects of conventional ventilation caused by the increase in intrathoracic pressure. But general anesthesia with jet ventilator has been dependent only on intravenous anesthetics. Therefore, this study was done to administer inhalation anesthetics(N2O, enflurane) during HFJV. This study was carried out from June 1992 to January 1993 in the 64 operated patients who beIonged to ASA class I, II in Chung Ang University Hospital The 22 patients using conventional ventilation were control group and the other 42 patients who had inhalation anesthesia by using HFJV were experimental group. In all patients, blood pressure and heart rate were checked on preinduction, postinductive 0, 5, 10, 15, 20, and 30 minutes. The result were as follows I) Systolic blood pressure was increased just on postinduction in both groups(P<0.05). It was decreased from postinductive 5 minutes to 30 minutes in control group, but there was no change in experimental group(P<0.05). 2) Diastolic blood pressure was increaeed just on postinduction in both groups(P<0.05). But it was increased from postinductive 5 minutes to 30 minutes in experimental group(P<0.05). 3) Mean blood pressure was increased just on postinduction in both groups(P<0.05). It was increased from postinductive 5 minutes to 15 minutes in control group and from postinductive 5 minutes to 30 minutes in experimental group(P<0.05). 4) Heart rate was increased just on postinduction and postinductive 5 minutes in control groupg <0.05), and increased from postinductive 0 minute to postinductive 30 minutes in experimental group(P<0.05). 5) pH was increased on postinductive 30 minutes compared to that of preinduction in both groups(P <0.05). 6) PaCO2 was more decreased on postinductive 30 minutes than preinduction in both groups (P<0.05), but there was no clinical significance. And PaO2 was increased at postinductive 30 minutes(P<0.05), which resulted from the increase of FiO2. As above results, inhalation anesthesia with HFJV is supposed to be useful if the difficulty of controlling the concentration of inhalation anesthetics and the contamination of operating room by expelled inhalation anesthetics were solved.
Anesthesia, General ; Anesthesia, Inhalation* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Blood Pressure ; Critical Illness ; Heart Rate ; Hemodynamics ; High-Frequency Jet Ventilation* ; Humans ; Hydrogen-Ion Concentration ; Inhalation* ; Operating Rooms ; Tidal Volume ; Ventilation ; Ventilators, Mechanical