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

Esophageal duplication is the congenital developmental anomaly manifestated as cystic or tubular type. The tubular esophageal duplication found at adult is extremely rare. A patient with tubular esophageal duplication is reported. A 37 years old male developed epigastric pain aggravated at hunger state from 2 monthes before administration. Gastrofiberscopy was done, and we could found the tubular esophageal duplication at 25 cm from incisiors. Esophagogram exposed the tunnel communicated with right anterior side of normal esophagus at upper and lower part of the tubular pathway with the length of 6 cm at T4-5 level. The microscopic finding of the tubular lumen revealed normal esophageal wall structure involving the outer part of muscle layer. Surgical resection was not done for the lesion was small and no symptom due to esophageal duplication was present. And so, the authors report this case as a tubular esophageal duplication with a literature review.
Adult ; Esophagus ; Humans ; Hunger ; Male

PURPOSE: This study aims to investigate preexposure prophylaxis and postexposure prophylaxis of rabies that the National Medical Center (NMC) handled and to check whether appropriate measures were performed according to the recent domestic and overseas guidelines after animal bites. METHODS: This study surveyed 41 people who were 18 years or under and received preexposure and postexposure prophylaxis of rabies at the NMC from November 2006 to December 2011. Their medical records were reviewed for their age, gender, the reason for preexposure prophylaxis, the body sites of animal bite, the kind of the animal that bit children, the region where the biting occurred and rabies vaccination and inoculation of immunoglobulin. RESULTS: Eleven children took rabies vaccination for preexposure prophylaxis and 30 children received post exposure prophylaxis of rabies. Of patients who were bitten by unvaccinated animals including wild animals or by animals which were not certain to be vaccinated, 50% (13 of 26 children) received postexposure prophylaxis, while 75% (3 of 4 children) of patients who were bitten by vaccinated animals received postexposure prophylaxis of rabies. Ten of 30 bitten patients knew whether or not the biting animals had received rabies vaccination. Of them, four people (40%) were bitten by animals which had received rabies vaccination. CONCLUSION: To prevent the occurrence of rabies, people and health care providers need to correctly understand latest guideline for rabies preexposure and postexposure prophylaxis and the information for bitten patient, biting animal and area at bitten by animal should be accurately recorded.
Animals ; Animals, Wild ; Bites and Stings ; Child ; Child Health ; Health Personnel ; Humans ; Isothiocyanates ; Medical Records ; Post-Exposure Prophylaxis ; Rabies ; Vaccination

No abstract available.
Hyponatremia* ; Hypopituitarism*

BACKGROUND AND OBJECTIVES: Metabolic syndrome and high sensitivity C-reactive protein (hs-CRP) are known to be strong predictors of coronary atherosclerosis. Even though there have been many observations and much research concerning the association of coronary atherosclerosis with CRP and metabolic syndrome, certain problems still need to be resolved in order to produce clear mechanistic illustrations. Therefore, the correlations of metabolic syndrome, hs-CRP and the severity of coronary atherosclerosis were evaluated herein. SUBJECTS AND METHODS: 271 patients, aged between 29 and 87, who had undergone diagnostic coronary angiograms at the National Medical Center, between January, 2004 and June, 2006 were evaluated. Coronary angiograms were performed in patients who complained of typical chest pain and had risk factors associated with coronary atherosclerosis. The correlations of metabolic syndrome, hs-CRP and coronary atherosclerosis were analyzed in these patients. RESULTS: Positive relationships were found between the metabolic syndrome risk factor clustering and an increased level of hs-CRP (p<0.01). The severity of coronary atherosclerosis increased with the increasing number of metabolic syndrome risk factors. As metabolic syndrome risk factor clustering increased, the quantity of 1, 2 and 3 vessel diseases also increased (Odd ratios 1.61, 1.83 and 2.50; p=0.001, <0.001 and <0.001, respectively). In contrast to metabolic syndrome risk factor clustering, no definite relationship between the hs-CRP level and the severity of coronary atherosclerosis was observed. CONCLUSION: The more metabolic syndrome risk factors clustered, the greater the severity of coronary atherosclerosis. The extension of coronary atherosclerosis maybe predicted using evaluation of metabolic syndrome risk factor clustering in patients with angina.
C-Reactive Protein ; Chest Pain ; Cluster Analysis* ; Coronary Angiography ; Coronary Artery Disease* ; Humans ; Metabolic Syndrome X ; Risk Factors*

OBJECTIVES: Refugees from North Korea are at risk of a range of mental health problems, posing urgent problems to their care. A review of research on mental health prevalence and services can indicate directions for further study. METHODS: The authors administered a Delphi survey to 16 professionals who are working for North Korean refugees, including professors and field workers. The collected data was analyzed by descriptive statistics including mean and standard deviation and verified with content validity ratio. RESULTS: The results are as follows: 1) The most serious problem in the research area is the importance of quantitative research rather than qualitative for North Korean refugees, who are often very negative and uncooperative with questionnaires. 2) There is a great need to develop competence of mental health professionals who are working for North Korean refugees. 3) Most participants agreed to the necessity of longitudinal study to define the factors facilitating successful adaptation among North Korean refugees. CONCLUSION: The following are our recommendations: 1) Appropriate measurements for North Korean refugees need to be developed reflecting their uniqueness. 2) Research of North Koreans has inherent selection bias. 3) It is essential to provide primary education on mental health to North Korean refugees.
Delphi Technique* ; Democratic People's Republic of Korea ; Education ; Health Personnel ; Humans ; Longitudinal Studies ; Mental Competency ; Mental Health* ; Prevalence ; Refugees* ; Selection Bias

We report a monozygotic twins with temporal lobe epilepsy, almost concordant in the onset time of firt seizure, lateralization and localization of epileptiform discharges. Partial seizures with secondarily generalized seizure occurred 15 days apart. EEG showed frequent spike-slow wave complexes on the right temporal area but the findings of brain MRI were normal in both. Past medical, delivery, developmental and family history were unremarkable. They had no physical and mental handicaps, and any other underlying causes of epilepsy. They have been on monotherapy with seizure free, although follow up EEG showed frequent spike-slow wave complexes after medication. As seizures developed simultaneously, the localization and lateralization of epileptiform discharges were concordant in our monozygotic twins, we suggest that genetic factor might be the most probable etiology of epilepsy in our cases but needs to be elucidated.
Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Follow-Up Studies ; Humans ; Seizures ; Temporal Lobe ; Twins, Monozygotic

Different types of aphasia resulting from stroke, as well as their anatomical correlates, are well characterized. In contrast, the literature on ictal aphasia is relatively scant. A 58-year-old woman had 4 times of transient motor aphasia. No other behavioral abnormalities and focal sensorimotor neurological deficits were revealed. Brain MRI showed a small meningioma at the left sphenoid ridge. Electroencephalogram showed occasional sharp waves on the left inferior frontal area. We report a rare case of ictal aphasia associated with meningioma.
Aphasia ; Aphasia, Broca ; Brain ; Electroencephalography ; Female ; Humans ; Meningioma ; Middle Aged ; Stroke

OBJECTIVES: Secondhand smoke is an issue that cannot be ignored due to its various negative effects. Especially, secondhand smoke inside the household is an area where health policy must pay attention as it can affect all age groups. This study aims to identify the factors associated with smoking inside the household focusing on socioeconomic status in Korea. METHODS: We used data from the Community Health Survey of 2017 and a total of 33,462 participated in the study. Data were analyzed through IBM SPSS version 25.0 to conduct binary logistic regression analysis. RESULTS: Results indicated that indoor smoking had a significant association with socioeconomic status. This association was more marked in those participants who had low household income or those with elementary school education level or less. Furthermore, the study indicates that when the smoker is a woman, older, has higher stress, and is a heavier smoker, the probability of her smoking inside the house is higher. CONCLUSIONS Based on the results, it is meaningful that this study has found the factors of smoking inside household. The result identify the factors associated with indoor smoking at home, and it can be used as baseline data for developing new smoking cessation policies.

OBJECTIVES: Secondhand smoke is an issue that cannot be ignored due to its various negative effects. Especially, secondhand smoke inside the household is an area where health policy must pay attention as it can affect all age groups. This study aims to identify the factors associated with smoking inside the household focusing on socioeconomic status in Korea. METHODS: We used data from the Community Health Survey of 2017 and a total of 33,462 participated in the study. Data were analyzed through IBM SPSS version 25.0 to conduct binary logistic regression analysis. RESULTS: Results indicated that indoor smoking had a significant association with socioeconomic status. This association was more marked in those participants who had low household income or those with elementary school education level or less. Furthermore, the study indicates that when the smoker is a woman, older, has higher stress, and is a heavier smoker, the probability of her smoking inside the house is higher. CONCLUSIONS Based on the results, it is meaningful that this study has found the factors of smoking inside household. The result identify the factors associated with indoor smoking at home, and it can be used as baseline data for developing new smoking cessation policies.