Purpose: We evaluated changes in the tear film parameters of the corneal surface, and their correlations with Munk scores,based on corneal topographic scans of patients with nasolacrimal duct obstructions who underwent dacryocystorhinostomy(DCR). We explored whether tear parameters can serve as useful indicators of functional surgical success. Methods: We assessed 72 eyes of 45 patients diagnosed with nasolacrimal duct obstruction who underwent DCR. Tear film parameterswere measured via corneal topography (Keratograph® 5M) once before, and three times after surgery, and includedtear meniscus height (TMH), and the initial and average keratographic tear break-up time (NIKBUT-first and NIKBUT-average,respectively; measured noninvasively). Results: The three postoperative TMH values were 0.31 ± 0.20, 0.30 ± 0.22, and 0.29 ± 0.15 mm, all of which were significantlylower than the preoperative value of 0.48 ± 0.29 mm (all, p < 0.001). Three months after surgery, the NIKBUT-first (6.90 ± 3.39seconds) was significantly shorter than the preoperative value (8.39 ± 5.34 seconds; p = 0.030). The preoperative NIKBUT-averagedid not differ significantly from the values at the three postoperative timepoints (p = 0.756, p = 0.753, and p > 0.999).Changes in the Munk score after surgery correlated significantly with changes in the TMH (r = 0.46, p < 0.001). When functionalsuccess was defined as a Munk score ≤ 1, the area under the curve (AUC) value corresponding to the ability of TMH to definefunctional success of 0.995, was statistically significant (cut-off of 0.31 mm; p < 0.001). Conclusions The TMH DCR correlated significantly with the Munk score, which is a quantitative measure of clinical symptomseverity. The ability of TMH to define functional surgical success was excellent.

Orofacial pain has various causes, making it challenging to differentiate from dentalrelated diseases based solely on symptoms. Toothache, usually attributed to pathological changes in the pulp and periodontal tissue, is the most common cause of orofacial pain and relatively easy to diagnose. However, distinguishing orofacial pain and nonodontogenic toothache due to myofascial, neuropathic, neurovascular, paranasal sinus and cardiac originating, and psychogenic pain presents diagnostic challenges that may result in incorrect treatment. Therefore, dentists must recognize that orofacial pain can arise from not only dental issues but also other causes. This case report explores the necessary considerations in diagnosing orofacial pain and nonodontogenic toothache by examining the diagnoses of patients presenting at the dental hospital with orofacial pain and nonodontogenic toothache of cardiac origin.

Background: To compare the risk of low back pain (LBP) and related spinal diseases between smokers (exposure group) and nonsmokers (non-exposure group). No large registry study has so far investigated the association between smoking and LBP-related spinal diseases such as intervertebral disc disease, spinal stenosis, spinal instability, and spondylolisthesis. Methods: A random sample was taken from the Korean National Health Insurance Research Database. In total, 204,066 men (160,105 smokers, 43,961 nonsmokers) who were followed up between 2002 and 2013 were included in the analysis. Patients with previous back pain or spinal disease in 2003 and 2004, patients with inappropriate data, and women (due to the lower percentage of smokers) were excluded. The Cox proportional hazard model was used to investigate the risk of LBP and related spinal diseases associated with smoking, while adjusting for demographic, clinical, and socioeconomic factors. Results: The overall median follow-up period was 5.6 years (interquartile range, 3.48–8.43 years). Compared to the nonsmoker group, the smoker group had a higher incidence of LBP (p = 0.01), intervertebral disc disease (p < 0.001), spinal stenosis (p = 0.004), spinal instability (p < 0.001), and spondylolisthesis (p = 0.023). Compared to the nonsmoker group, the smoker group had a higher adjusted hazard ratio (HR) per year of LBP (HR, 1.18; 95% confidence interval [CI], 1.15 to 1.21), intervertebral disc disease (HR, 1.25; 95% CI, 1.21 to 1.30), spinal stenosis (HR, 1.52; 95% CI, 1.41 to 1.64), spinal instability (HR, 1.33; 95% CI, 1.24 to 1.44), and spondylolisthesis (HR, 1.49; 95% CI, 1.23 to 1.80). Conclusions Smokers in male samples were at higher risk for LBP and related spinal diseases than nonsmokers.

Purpose: Frail older adults have a higher risk of hospital readmission due to decline in physical, functional, and psychological health status. The impact of readmission on individuals, families, or the healthcare system is tremendously devastating. This study aimed to investigate factors associated with hospital readmission of frail older adults. Materials and Methods: This was a retrospective descriptive study based on multi-professional health assessments found in electronic medical records of patients from a university-affiliated hospital in Seoul, Korea. The participants were 141 older adults who were admitted to the geriatric department with medical problems. Frailty, components of the comprehensive geriatric assessment including nutrition, physical functions, psychological and cognitive status, clinical data including length of hospital stay, and readmission within 30, 90, and 180 days were collected. Survival analysis was performed, and Cox proportional hazard regression model was used to investigate the risk factors for readmission. Results: The statistically significant variables at each time point were slightly different. However, at most time points, disease-related problems (i.e., comorbidities and medications) and body functions (i.e., grip strength and physical activity) were included. The median duration until readmission was 27 days, and grip strength was found to be significantly related to readmission (p=0.020). Conclusion After discharge, both medical services to manage the medical condition and intervention to maintain physical function are needed to prevent frail older adults from being readmitted to the hospital.

Purpose: Frail older adults have a higher risk of hospital readmission due to decline in physical, functional, and psychological health status. The impact of readmission on individuals, families, or the healthcare system is tremendously devastating. This study aimed to investigate factors associated with hospital readmission of frail older adults. Materials and Methods: This was a retrospective descriptive study based on multi-professional health assessments found in electronic medical records of patients from a university-affiliated hospital in Seoul, Korea. The participants were 141 older adults who were admitted to the geriatric department with medical problems. Frailty, components of the comprehensive geriatric assessment including nutrition, physical functions, psychological and cognitive status, clinical data including length of hospital stay, and readmission within 30, 90, and 180 days were collected. Survival analysis was performed, and Cox proportional hazard regression model was used to investigate the risk factors for readmission. Results: The statistically significant variables at each time point were slightly different. However, at most time points, disease-related problems (i.e., comorbidities and medications) and body functions (i.e., grip strength and physical activity) were included. The median duration until readmission was 27 days, and grip strength was found to be significantly related to readmission (p=0.020). Conclusion After discharge, both medical services to manage the medical condition and intervention to maintain physical function are needed to prevent frail older adults from being readmitted to the hospital.

PURPOSE: Pandemic influenza A (H1N1) virus has spread rapidly and prompt diagnosis is needed for successful treatment and prevention of transmission. We investigated clinical predictors, validated the use of previous criteria with laboratory tests, and evaluated the clinical criteria for H1N1 infection in the Korean population. MATERIALS AND METHODS: We analyzed clinical and laboratory evaluation data from outpatient clinics at Severance Hospital in Seoul, Korea between November 11 and December 5, 2009. RESULTS: This analysis included a total of 828 patients. Of these, 372 (44.9%) patients were confirmed with H1N1 infection by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The most common and predictive symptom was cough (90.3%, OR 8.87, 95% CI 5.89-13.38) and about 40% of H1N1-positive patients were afebrile. The best predictive model of H1N1 infection was cough plus fever or myalgia. The sensitivities, specificities, positive predictive values, and negative predictive values of our suggested criteria were 73.9%, 69.5%, 66.4%, and 76.6%, respectively. CONCLUSION: Cough was the most common independent symptom in patients with laboratory-confirmed H1N1 infection, and while not perfect, the combination of cough plus fever or myalgia is suggested as clinical diagnostic criteria. Health care providers in Korea should suspect a cough without fever to be an early symptom of H1N1 infection.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Influenza A Virus, H1N1 Subtype/*metabolism ; Influenza, Human/*diagnosis/*epidemiology/virology ; Male ; Middle Aged ; Pandemics ; Predictive Value of Tests ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity

PURPOSE: We studied the management of young children with histories of food allergies at child care centers, along with the diagnosis and follow-up management after a visit to a hospital emergency department (ED). METHODS: 1) The survey was conducted in April 2010 in Seoul, Korea. Three hundred forty-five child care centers caring for children between the ages of 0 and 5 years were contacted by mail. The questionnaire was designed to identify symptoms and management of children in child care centers with histories of food allergies. 2) We studied children who were diagnosed with angioedema or anaphylaxis between January 2002 and August 2010 in the ED of Korea University. RESULTS: 1) According to the 345 collected questionnaires, 243 child care centers asked parents about their children's allergic diseases and 492 children had food allergies. A reported 461 children from 207 child care centers had food restrictions. Only 21 child care centers supplied substitute foods with the same amounts and types of nutrients. One hundred forty-five teachers had received education about food allergies. 2) Thirty children were diagnosed with anaphylaxis or angioedema after food ingestion. Only seven children visited a physician after being discharged from the ED. CONCLUSION: This study identified a lack of food allergy education at child care centers and in homes. Child care centers need to be equipped with knowledge to prevent severe allergic reactions. Also, parents should know more about the importance of food allergies in their children.
Anaphylaxis ; Angioedema ; Child ; Child Care ; Eating ; Emergencies ; Follow-Up Studies ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Korea ; Parents ; Postal Service ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the long-term outcome of primary endoscopic dacryocystorhinostomy (DCR) or conjunctivo-dacryocystorhinostomy (CDCR) in adults with nasolacrimal duct obstruction. SUBJECTS AND METHOD: We retrospectively reviewed 31 eyes of 27 patients who underwent primary DCR or CDCR for anatomical or functional blockage of the lacrimal drainage system (4 males, 27 females, mean age 54.4+/-12.7 years). The mean follow-up period was 45.4+/-10.8 months. The main outcome measure for success was assessed by symptomatic improvement. Pre-operative CT findings and endoscopic findings, sites of obstruction, types of surgery, post-operative complications were evaluated and the outcome was assessed according to the level of obstruction and types of surgery. RESULTS: Two years after the surgery, the success rate was 83.9% including complete resolution of symptoms (64.5%) and partial improvement (19.4%). No improvement was reported in 16.1%. There was no significant difference in success rates of DCR according to the obstruction sites. Patients with functional blockage had worse success rate than those with anatomical obstruction. CONCLUSION: Both endoscopic DCR and CDCR had successful outcome in the long term con-trol of epiphora and functional nasolacrimal duct obstruction showed worse prognosis when compared with anatomical obstruction.
Adult ; Dacryocystorhinostomy ; Drainage ; Eye ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Male ; Nasolacrimal Duct ; Outcome Assessment (Health Care) ; Prognosis ; Retrospective Studies

AIMTo investigate the antioxidant effects of Morinda officinalis (Morindae radix, MR) on H(2)O(2)-induced oxidative stress in cultured mouse TM3 Leydig cells.

METHODSWe carried out 2,2-diphenyl-1-picrylhydrazyl free radical scavenging, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, lipid peroxidation, testosterone enzyme immunoassay, superoxide dismutase (SOD), and catalase (CAT) assays in Leydig TM3 cells.

RESULTSMR showed a 47.8% 2,2-diphenyl-1-picrylhydrazyl radical scavenging effect in TM3 cells with no significant cytotoxicity. Oxidative stress was induced in TM3 cells with 100 micromol H(2)O(2), and treatment of the cells with 250 microg/mL MR showed the most significant protective effect (64%, P < 0.001) in the cell viability assay with a decreased lipid peroxidation level (1.75 nmol/mg protein, P < 0.05), increased testosterone production (43.5 pg/mL), and improvements in SOD activity (7.49 units of SOD/mg protein, P < 0.001) and CAT activity (74.6 units of CAT/mg protein, P < 0.001).

CONCLUSIONThese findings indicate that MR, as an antioxidant, protects functions of cultured mouse TM3 Leydig cells from H(2)O(2)-induced oxidative stress.

Animals ; Catalase ; metabolism ; Cell Survival ; drug effects ; Cells, Cultured ; Hydrogen Peroxide ; adverse effects ; Leydig Cells ; cytology ; drug effects ; metabolism ; Lipid Peroxidation ; drug effects ; Male ; Mice ; Morinda ; Oxidative Stress ; drug effects ; Plant Extracts ; pharmacology ; RNA, Messenger ; metabolism ; Superoxide Dismutase ; metabolism ; Testosterone ; metabolism

BACKGROUND AND OBJECTIVES: The sphenoidotomy removing inferomedial side of anterior sphenoid wall has been the standard procedure to enter the sphenoid sinus. In this paper, we evaluated the feasibility and safety of superolateral sphenoidotomy based on the radiological analysis of the sphenoid sinus. SUBJECTS AND METHOD: Seventy-six multiplanar reconstructive computed tomography (CT) scans were reviewed to investigate dimensions of the sphenoid sinus. We measured the length from sphenoid ostium to optic canal and to carotid artery, and also measured the thickness of both upper and lower bony part of sphenoid ostium. The subjects were divided into two groups; one with sphenoid sinusitis and the other without sinusitis and all the measurements were evaluated and were compared between groups. RESULTS: The mean length from sphenoid ostium to optic canal were 13.8+/-2.4 mm in control group and 12.9+/-2.2 mm in sinusitis group. The length from sphenoid ostium to carotid artery were 10.4+/-1.5 mm and 10.0+/-1.8 mm in control and sinusitis group, respectively. There were significant differences in both lengths between control and sinusitis group. The bony thickness above and below the ostium were 1.48+/-0.31 mm and 1.73+/-0.27 mm respectively and were significantly different from each other (p<0.001). CONCLUSION: Since the neurovascular structures was relatively distant from the sphenoid ostium and the bony thickness below the ostium was significantly thicker than that above the ostium, the sphenoidotomy removing superolateral side of anterior sphenoid wall could be an alternative procedure, especially, in patients with a thickened bone around sphenoid ostium.
Carotid Arteries ; Humans ; Sinusitis ; Sphenoid Sinus ; Sphenoid Sinusitis