BACKGROUND AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. METHODS: We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). RESULTS: Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. CONCLUSIONS: The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.
Cerebrospinal Fluid ; Cranial Nerves ; Diplopia ; Female ; Follow-Up Studies ; Guillain-Barre Syndrome ; Humans ; Jupiter ; Male ; Miller Fisher Syndrome ; Ophthalmoplegia ; Paresis ; Strabismus

Since G.N. Hounsfield's clinical use of computed tomography in 1971, digital imaging technique using computers has shown an eye opening progress. Progress has made 3-dimensional understanding of not only facial bones but muscles and other connective tissues possible through 3-dimensional reconstruction of preexisting tomographical images. Also, quantitative analysis of density, distance, volume has become possible, allowing objective analysis of preoperative and postoperative states through imaging. The authors measured the masseter muscle volume of 20 normal individuals and 8 female patients through 3-D reconstructive CT imaging and made a statistical analysis of the measurements. The method used in our study may be applied to the diagnosis of disease causing the change of the facial volume and presurgical design as a useful tool to provide objective information on the evaluation of surgery outcome.
Connective Tissue ; Diagnosis ; Facial Bones ; Female ; Humans ; Masseter Muscle* ; Muscles

No abstract available.
Heart Neoplasms*

Parotid sialolithiasis accounts for 10 to 20% of all cases of sialolithiasis that involves the head and neck and presents management challenges for a variety of reasons. In this report, we present a rare case of removing a double stone in Stensen's duct by anexternal approach (open parotid sialolithotomy).
Head ; Neck ; Salivary Duct Calculi ; Salivary Ducts ; Salivary Gland Calculi

BACKGROUND: Despite proposing clonal depletion, anergy, and alternation of cytokines in peripheral tolerance, the precise mechanism for the immunosuppressive effect of blood transfusion remains unknown. Here, we evaluated the effect of transfusion on the immune system indirectly via quantitation of leukocyte cytokine mRNA expression before and after allogeneic transfusion. METHODS: Samples were obtained from eight patients, being ordered one to four units of leukocytefree erythrocytes, before, 1, and 7 days after transfusion, from November to December, 2002 at Inha University Hospital. We explored the changes in mRNA expression of interleukin-2 (IL-2), IL-4, IL-10, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma). RESULTS: In four patients who received blood transfusions among eight, significant changes were observed in the blood mRNA levels of INF-gamma and IL-10. The amounts of IFN-gamma mRNA were significantly decreased a day after transfusion to 78.5% and then recovered to 110.9% 7 days later (P=0.032), whereas, that of IL-10 was increased to 151.5% a day after and recovered to 119.1% 7 days later (P=0.034). mRNA expressions of IL-2, IL-4, and TNF-alpha were not detected in all patients. CONCLUSIONS: We observed a significant decrease in leukocyte IFN-gamma mRNA expression and an increase in IL-10 mRNA after transfusion. These findings indirectly represent that down-regulation of the Th1 cells and the up-regulation of the Th2 cells could be caused by allogeneic transfusion.
Blood Transfusion ; Cytokines ; Down-Regulation ; Erythrocytes ; Humans ; Immune System ; Interferons ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Leukocytes ; Peripheral Tolerance ; RNA, Messenger* ; Th1 Cells ; Th2 Cells ; Tumor Necrosis Factor-alpha ; Up-Regulation

BACKGROUND: For monitoring infection and inflammation episodes, biomarkers of host response, such as C-reactive protein (CRP) and procalcitonin (PCT), are now being recognized as useful tools in the diagnostic process. We aimed at evaluating the analytical performance of the recently developed semi-automated ichroma SMART system (Boditech Med Inc., Korea), which allows measurements of both CRP and PCT. METHODS: We evaluated the analytical performance of the ichroma SMART system and the agreement between its results and the laboratory standards for CRP and PCT measurements. The precision and linearity as well as the method of measurement were compared to the DxC 800 (Beckman Coulter, USA) for CRP and to the VIDAS (bioMerieux SA, France) for PCT, according to corresponding CLSI guidelines. Additionally, we evaluated the carryover rates between specimens. RESULTS: The total precision (% CV) of the ichroma SMART system in measuring low, middle, and high level controls (level 1, 2, 3) was 6.32%, 5.75%, and 3.56% for CRP, and 8.07%, 6.24%, and 6.53% for PCT. In the linearity test, R2 was 0.9997 and 0.9982 for CRP (0.1-336.8 mg/L) and PCT (0.05-60.91 ng/mL), respectively. Good correlation was observed between ichroma SMART and DxC 800 for CRP (r=0.997), and between ichroma SMART and VIDAS for PCT (r=0.992). Carry-over effect was 0.02% for CRP and 0.04% for PCT. CONCLUSIONS: The ichroma SMART system showed an adequate performance and appeared to be a suitable clinical analyzer with a simple operating procedure for the measurement of CRP and PCT.
Biomarkers ; C-Reactive Protein* ; Inflammation

BACKGROUND: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea. CASE REPORT: A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale. CONCLUSIONS: The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."
Cold Temperature ; Environmental Medicine ; Fingers ; Foot ; Hand ; Hand-Arm Vibration Syndrome ; Humans ; Male ; Mandrillus ; Middle Aged ; Neural Conduction ; Photoplethysmography ; Plethysmography ; Toes ; Vibration ; Water

No abstract available.
Diagnosis* ; Thrombosis*

No abstract available.
Aortic Stenosis, Supravalvular*

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.
Adult ; Age Factors ; Aged ; Breast Neoplasms/*epidemiology ; Case-Control Studies ; Female ; Human ; Korea/epidemiology ; Menstruation/*physiology ; Middle Age ; Pregnancy ; Reproduction/*physiology ; Risk Factors