Canalith repositioning maneuver is effective to treat benign paroxysmal positional vertigo(BPPV). This case showed complicated form of the BPPV such as changes of canalolithiasis to cupulolithiasis, involvement of one canal to two canals and from unilateral to bilateral involvement during the reposition maneuver. This patient was diagnosed as left lateral canalolithiasis at first. After left barbecue maneuver, the type was changed to the right posterior cupulolithiasis. Semont maneuver was performed and then the type of BPPV was changed to combined type with right posterior canalolithiasis and left lateral canalolithiasis. We performed left barbecue maneuver and right Epley maneuver. Then the type of BPPV was changed to left lateral cupulolithiasis. After Brandt-Daroff maneuver and left barbecue maneuver, nystagmus and dizziness disappeared finally.
Dizziness ; Humans

Purpose: This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants’ knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P＜0.01).The women were more likely to be willing to write ADs in the future when they reporteda middle income level rather than a lower income level (odds ratio [OR]=5.952, P＜0.01), considered themselves unhealthy (OR=5.873, P＜0.01), and graduated college or higher (OR=4.096, P＜0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P＜0.05) and on their families (OR=1.447, P＜0.05) were morelikely to be willing to write an AD. Conclusion This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women.

Purpose: This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants’ knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P＜0.01).The women were more likely to be willing to write ADs in the future when they reporteda middle income level rather than a lower income level (odds ratio [OR]=5.952, P＜0.01), considered themselves unhealthy (OR=5.873, P＜0.01), and graduated college or higher (OR=4.096, P＜0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P＜0.05) and on their families (OR=1.447, P＜0.05) were morelikely to be willing to write an AD. Conclusion This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women.

Objectives: To determine the factors affecting the decline in ovarian reserve following laparoscopic ovarian cystectomy (LOC) in women with ovarian endometriosis. Methods: This retrospective study included 22 women, aged 25–45 years, with regular menstrual cycles who underwent unilateral LOC and were diagnosed with ovarian endometriosis at a university hospital. Blood samples were collected preoperatively and on the third postoperative day to determine the serum anti-Müllerian hormone (AMH) levels for assessment of the decline in ovarian reserve during the early postoperative period. Results: The preoperative hemoglobin level, white blood cell count, and AMH level were associated with changes in the AMH level after unilateral LOC. Among these parameters, only the preoperative hemoglobin level was correlated with the rate of decline in postoperative AMH levels. The preoperative serum AMH level was correlated with the amount of postoperative AMH change but not with its rate of decline. Conclusions Preoperative hemoglobin levels may be associated with the rate of decline in AMH levels in the early postoperative period after unilateral LOC.

BACKGROUND:Many patients with symptom of recurrent episodic vertigo can neither be diagnosed nor treated. The purpose of this study is to review clinical features of a group of patients with recurrent episodic vertigo that is not defined to specific diagnosis of vertigo and to test the effectiveness of phenytoin sodium in the patients. METHOD & MATERIAL:11 of 32 patients with recurrent vertigo not defined to specific diagnostic category of vertigo who visited dizziness center of a tertiary care university hospital from November 1995 to April 2004 were studied. The patient's charts were reviewed retrospectively. A thorough otolaryngologic and neurotologic evaluation was performed in every case to determine the specific cause of dizziness. Vestibular function test, hearing test, magnetic resonance imaging of brain, electroencephalogram, and 24 hour Holter EKG monitoring were performed in all cases. Consultations to psychiatrist and neurologist were obtained. All patients were treated with phenytoin sodium. RESULT:The results of the vestibular function test, audiogram, MRI of brain, electroencephalogram, 24-hr holter monitoring were normal. Any definitive diagnosis could not be reached to this group. Vertigo was controlled by phenytoin sodium in all 11 cases. CONCLUSION:We report a group of patients with recurrent episodic vertigo that is not defined to any specific diagnosis of vertigo. The vertigo symptom was controlled successfully by phenytoin sodium. This patients were diagnosed as benign episodic vertigo as a separate disease entity.
Brain ; Diagnosis ; Dizziness ; Electrocardiography ; Electrocardiography, Ambulatory ; Electroencephalography ; Hearing Tests ; Humans ; Magnetic Resonance Imaging ; Phenytoin* ; Psychiatry ; Referral and Consultation ; Retrospective Studies ; Sodium* ; Tertiary Healthcare ; Vertigo* ; Vestibular Function Tests

PURPOSE: A tumor and mature ovarian cystic teratoma rarely coexist, but since it may affect treatment andprognosis, appropriate pre-surgical diagnosis is important. The purpose of this study was to evaluate thedifference in CT findings between a tumor coexisting with a mature ovarian cystic teratoma and a simple matureovarian cystic teratoma. MATERIALS AND METHODS: CT scans of seven cases of tumor coexisting with mature ovariancystic teratoma were reviewed. In each case, size, margin, nature, septation, solid portion, ascites, invasion,and metastasis were analysed. RESULTS: Coexistent tumors were histopathologically diagnosed as squamous cellcarcinoma in three patients, carcinoid in three, and fibrothecoma in one. In contrast with a simple matureteratoma, a tumor coexisting with a mature cystic teratoma developed in older patients and had a more solidportion, which showed contrast enhancement but did not show calcification or a fat component. Where a tumor andmature cystic teratoma coexisted, ascites and the invasion of adjacent structures were also common. CONCLUSION: If, in an older patient, CT scanning reveals an ovarian cystic tumor with a large solid portion but nocalcification or fat, coexistent tumor should be suspected.
Ascites ; Carcinoid Tumor ; Diagnosis ; Female ; Humans ; Neoplasm Metastasis ; Ovarian Cysts ; Teratoma* ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to compare the diagnostic accuracies of chest radiographs and chest CTin the diagnosis of a solitary pulmonary nodule(SPN), and to determine the role of CT and CT findings which aid inthe differential diagnosis of nodules. MATERIALS AND METHODS: A retrospective study was done on 54 patients inwhom SPN was found on chest radiographs and chest CT was carried out. The study involved 25 benign and 29 malignant nodules, confirmed histopathologically and clinically. Chest radiographs and CT scans were reviewed separately in randomized order by two chest radiologists who for each film listed the three most likely diagnose sin descending order. The radiologists recorded the confidence value of the most probable diagnosis, and also the marginal and internal characteristics of nodules and their size, as nodules seen on chest CT scans. RESULTS: Diagnostic rates in the differential diagnosis of benign and malignant nodules were 65.7% by radiography and 77.8% by CT. Correct first-choice diagnosis was by radiography in 30.6 % of cases, and by CT in 41.7%. Using radiographs, and the correct diagnosis was among the top-three choices in 61.1% of cases ; with CT, the corresponding figure was 76.8%. Overall, a confident diagnosis was reached more often with the CT(41.7%) than with the chest radiograph(21.4%) ; diagnaotic accuracy was 60.0% and 52.2%, respectively. CT findings which imply abenign nodule include smooth margins and diffuse internal calcifications, whereas marginal lobulations, air-bronchograms, internal low density without cavitation, eccentric calcifications, and large size suggest malignancy. We faund that CT findings such as well-defined margins, spiculations, pleural tail or internal homogeneity did not contribute in the differentiation between benign and malignant nodules. CONCLUSION: CT issuperior to chest radiography in the differential diagnosis of the solitary pulmonary nodule. Using CT, diagnosis was accurate and made with a high level of confidence, especially with the application of CT findings which aid inthe differential diagnosis of nodules.
Diagnosis ; Diagnosis, Differential* ; Humans ; Radiography* ; Radiography, Thoracic ; Retrospective Studies ; Solitary Pulmonary Nodule* ; Thorax* ; Tomography, X-Ray Computed

OBJECTIVE: Lung cancer arises after a series of morphological changes, which take several years to progress from normal epithelium to invasive cancer. Multiple molecular changes and growth factors factor production have been documented in lung cancers, both small cell and non-small cell types. Insulin-like growth factors(IGFs) are important mitogenic and anabolic peptides, both in vivo and in vitro, and are thought to be significant autocrine-paracrine factors involved in normal and malignant cell proliferation. In this study, we have investigated (delete) the degree of expression of IGF-1 on the immunohistochemical staining in human non-small cell lung cancer(NSCLC) cells and small cell lung cancer (SCLC) cells were investigated. METHODS: Immunohistochemical staining for IGF-1 was performed in 15 cases of small cell carcinoma, 15 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, and 12 cases of bronchoalveolar carcinoma. RESULTS: The NSCLC cells showed significantly increased expression The expression of IGF-1 on the immunohistochemical staining significantly increased in NSCLC cells than in SCLC cells. CONCLUSION: These results suggest that IGF-1 are expressed the expression of IGF-1 in human lung cancer cells(.), and the (The) immunohistochemical staining of IGF-1 in lung cancer cell lines may help in differentiation of may assist in the differentiation of NSCLC and SCLC.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Cell Line ; Cell Proliferation ; Epithelium ; Humans* ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins ; Lung Neoplasms* ; Lung* ; Peptides ; Small Cell Lung Carcinoma

Relapsing polychondritis (RP) is a rare inflammatory disorder of unknown etiology, causing recurrent inflammatory and degenerative reactions involving the cartilaginous structures throughout the body. Generally, RP is known as multiorgan disease presented as auricular chondritis, arthritis, nasal chondritis, ocular inflammation, audiovestibular damage and respiratory tract inflammation. Major airway involvement occurs in more than 50% of the patient and has been reported to be the primary cause of death. Rarely, it may be presented with only respiratory symptoms without typical clinical manifestation of RP. We experienced a 64-year-old male patient with RP involving diffuse airway tract without other characteristic clinical manifestation and present here with a review of literatures.
Arthritis ; Cause of Death ; Humans ; Inflammation ; Male ; Middle Aged ; Polychondritis, Relapsing* ; Respiratory System

A 36 year-old woman immigrated from Nepal showed erythematous plaques on her face, buttock and legs one month after the immigration. Before the correct diagnosis was made, the patient had been erroneously treated as anallergic dermatitis for three months. Clinico-pathologically, her skin lesion was borderline lepromatous type leprosy with bacilli positive. We report the case to keep the high index of suspicion for leprosy when we meet with patients from the countries where leprosy is still epidemic.
Buttocks ; Dermatitis ; Emigrants and Immigrants ; Emigration and Immigration ; Female ; Humans ; Leg ; Leprosy ; Leprosy, Multibacillary ; Nepal ; Skin