Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Antifungal Agents ; Aspergillosis* ; Aspergillus ; Biopsy ; Blindness* ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Cranial Nerves ; Delayed Diagnosis ; Diagnosis ; Early Diagnosis ; Headache* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Optic Nerve ; Orbit ; Sphenoid Sinus* ; Sphenoid Sinusitis

OBJECTIVES: This survey study was conducted to investigate the effect of smoking on drinking alcohol, depression, anxiety and impulsiveness. METHODS: The survey participants were 925 residents over 20 years of age in Gwanak-gu, Seoul. Subjects were divided into smoking and non-smoking groups, and all completed the Korean Version of the Alcohol Use Disorder Identification Test (AUDIT-K), the Beck Depression Inventory (BDI), the Barret Impulsiveness Scale (BIS) and the State-Trait Anxiety Inventory (STAI) to identify patterns of the alcohol consumption and smoking, and to assess levels of depression, anxiety and impulsiveness. RESULTS: The number of subjects with problem drinking was significantly higher in smokers (n=58, 37.2%) than non-smokers (n=81, 11.1%), and there was also a significant difference between smokers and non-smokers on the BDI. However, there were no significant differences between smokers and non-smokers on either the BIS or the STAI. When smokers with problem drinking (Smk_Alc) and smokers without problem drinking (Smk_non-Alc) were compared, the Smk_Alc subjects were found to have higher BDI and trait anxiety scores than the Smk_non-Alc group. CONCLUSION: The results of this study indicate that smoking is closely related to drinking alcohol and suggests that the more frequently people smoke, the more likely they will drink alcohol due to depression and anxiety. It may therefore important for smokers to control depressive mood, anxiety and impulsivity.
Alcohol Drinking ; Anxiety ; Depression ; Drinking ; Drinking Behavior ; Smoke ; Smoking

PURPOSE: We evaluated the MRI findings that suggested the presence of a residual cancer after a mammotome biopsy in pathologically proven breast cancer patients and the usefulness of MRI to diagnose a residual cancer and additional lesions. MATERIALS AND METHODS: We reviewed 41 breast cancer patients that underwent an ultrasonography-guided mammotome biopsy for complete resection of a breast lesion. MRI was performed for preoperative assessment and MRI findings suggestive of a residual cancer at the procedure site were analyzed and correlated to the pathological findings. Additional enhancements on breast MRI were analyzed, and the diagnostic accuracy of MRI for occult additional lesions was calculated. RESULTS: A total of 32 (78.0%) patients had a residual tumor. A mass was the most common MRI finding that suggested a residual cancer. Thick rim enhancement or a mass with a non-mass like enhancement were the most suspicious findings that suggested the presence of a residual cancer. The sensitivity, specificity and accuracy of MRI for the detection of a residual cancer were 81.3%, 66.7% and 78.0%, respectively. Additional malignant lesions were found in 7 cases. The sensitivity, specificity and accuracy of MRI for the detection of additional lesions were 100%, 60.0% and 76.5%, respectively. CONCLUSION: Further complete surgery should be performed, as residual tumors are found in 50% of the negative MRI examinations, whereas preoperative MRI is helpful to evaluate occult additional lesions.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Magnetic Resonance Imaging* ; Neoplasm, Residual ; Sensitivity and Specificity ; Ultrasonography, Mammary

The purpose of this study was to compare the sealing abilities of four endodontic temporary restorative materials using a methylene blue dye penetration test under dynamic loading. Standardized access cavities were prepared in forty-four intact human permanent molar teeth, and the cavities were restored with Caviton, MD-Temp, IRM, or ZOE. After thermocycling, an intermittent load of 98 N at 1 Hz was applied for 1,000 cycles to the long axis of the functional cusp of each of the teeth, which were immersed in a 1% methylene blue solution. The teeth were split in half, and the linear depth of dye penetration was evaluated according to the criteria. The results were analyzed using one-way ANOVA (p = 0.05) and Duncan's multiple range test. The results demonstrated that Caviton and MD-Temp showed significantly lower microleakage than IRM and ZOE. It was concluded that Caviton and MD-Temp exhibited better sealing ability than IRM and ZOE under dynamic loading.
Axis, Cervical Vertebra ; Calcium Sulfate ; Dental Cements ; Humans ; Methylene Blue ; Molar ; Root Canal Filling Materials ; Tooth ; Vinyl Compounds ; Zinc Oxide

PURPOSE: We wanted to investigate the effect of sublingual nitroglycerin (NTG) on improving the image quality and diagnostic accuracy of coronary computed tomographic angiography (CTA) for detecting atherosclerosis and significant stenosis. MATERIALS AND METHODS: We retrospectively assessed the data of 81 patients who underwent coronary CTA. Forty three patients underwent coronary CTA without medication (the non-administrated group), while 38 patients were given 0.6 mg NTG sublingually before coronary CTA (the administrated group). Image quality was assessed using a five-point grading scale. We evaluated the diagnostic performance of coronary CTA for assessing atherosclerosis and significant stenosis (> or = 50%) in the 42 patients who underwent invasive coronary angiography. RESULTS: The mean image-quality grades were 4.09+/-0.72 and 4.50+/-0.60 in the non-administrated and administrated groups, respectively (p=0.008). On the per-artery analysis, the accuracy percentages for detecting coronary CTA were 65 and 88% for atherosclerosis and 82 and 80% for significant stenosis in the non-administrated and administrated groups, respectively. On the per-patient analysis, the positive predictive values for coronary CTA were 80% and 100% for atherosclerosis and 77% and 88% for significant stenosis in the non-administrated and administrated groups, respectively. CONCLUSION: Coronary CTA with NTG administration improved the image quality. The accuracy of coronary CTA for detecting atherosclerosis was higher in the administrated group than in the non-administrated group.
Administration, Sublingual* ; Angiography* ; Atherosclerosis ; Constriction, Pathologic ; Coronary Angiography ; Humans ; Nitroglycerin* ; Retrospective Studies

Ankylosis ; Arthroplasty ; Chin ; Chronic Pain ; Facial Asymmetry ; Humans ; Joints ; Molar ; Mouth ; Oral Hygiene ; Temporomandibular Joint

Anesthesia, Local ; Conscious Sedation ; Humans ; Joints ; Mouth ; Recurrence ; Splints ; Therapeutic Irrigation

BACKGROUND: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). METHODS: Participants in this study consisted of 65 type 2 diabetes patients (M : F = 45 : 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 +/- 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. RESULTS: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 +/- 2.5 vs. 50.5 +/- 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 +/- 0.7 vs. 24.6 +/- 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 +/- 1.48 vs. 4.71 +/- 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). CONCLUSION: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.
Blood Pressure ; Body Mass Index ; Diabetes Mellitus ; Electrocardiography ; Fasting ; Glucose ; Heart Diseases ; Hemoglobins ; Humans ; Hypertension ; Insulin ; Myocardial Ischemia ; Risk Factors ; Smoke ; Smoking

PURPOSE: To study clinical features and patterns of recurrence after breast-conserving treatment (BCT) for three molecular subtypes of early stage breast cancer. METHODS: The sample studied included 596 patients with T1-2N0-1 breast cancer who received BCT. Three groups were defined by receptor status. Luminal: estrogen receptor (ER) or progesterone receptor (PR) positive; triple negative (TN): ER, PR, and epidermal growth factor receptor-2 (HER2) receptor negative; and HER2 overexpressing: ER and PR negative but HER2 receptor positive. RESULTS: The number of patients in each group was 408 (68.5%), 105 (17.6%), and 83 (13.9%), respectively. The median follow-up period was 79 months. The TN and HER2 subtypes occurred in younger patients (p=0.0007) and had higher nuclear grade and poorer histologic grade (p<0.0001 and 0.0071, respectively). During the follow-up period, locoregional recurrence was detected as the first site of recurrence in 26 (6.4%), 11 (10.5%), and 9 (10.8%) patients in the luminal, TN, and HER2 subtypes, respectively (p=0.1924). Thirty-one (7.6%), 7 (6.7%), and 7 (8.4%) patients in each group had distant metastases as the first sign of recurrence (p=0.8996). Median time to locoregional and distant recurrence was shorter in the HER2 subtype (p=0.0889 and 0.0780, respectively), and the HER2 subtype was significantly associated with poor overall survival (p=0.0009). CONCLUSION: After BCT in Korean women with early stage breast cancer, the patterns of recurrence were not different among the molecular subtypes, although the TN and HER2 subtypes were associated with younger age, higher nuclear grade, and poorer histologic grade.
Breast ; Breast Neoplasms ; Epidermal Growth Factor ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Segmental ; Neoplasm Metastasis ; Phenobarbital ; Receptor, erbB-2 ; Receptors, Estrogen ; Receptors, Progesterone ; Recurrence

The most common symptoms of pheochromocytoma are paroxysmal or sustained hypertension, or symptoms of paroxysmal adrenergic stimulation such as palpitation, headache, and diaphoresis. These patients can on rare occasion reveal or be complicated with cardiovascular symptoms such as arrhythmia, cardiomyopathy, acute coronary syndrome and cardiogenic shock. These cardiac manifestations of pheochromocytoma may delay the diagnosis, which can cause a catastrophic outcome. A pheochromocytoma crisis is provoked by surgery, anesthesia, exercise and, several drugs and it is known to be an endocrine emergency with mortality as high as 85%. Many classes of drugs are well known to precipitate adverse reactions, but the presentation of pheochromocytoma after the administration of steroid has rarely been reported. We report here on a case of pheochromocytoma crisis with acute myocardial infarction after the patient took prednisolone. Furthermore, we discuss the mechanism of glucocorticoid induced crisis and myocardial infarction in pheochromocytoma patients.
Acute Coronary Syndrome ; Anesthesia ; Arrhythmias, Cardiac ; Cardiomyopathies ; Emergencies ; Glucocorticoids ; Headache ; Humans ; Hypertension ; Myocardial Infarction ; Pheochromocytoma ; Prednisolone ; Shock, Cardiogenic