No abstract available.

Pancreatic cancer is well known as a relentlessly progressive and fatal disease. Although distant metastasis is common at the time of diagnosis, brain metastasis originating from pancreatic cancer is rare and its clinical manifestation remains poorly described. Additionally, it is generally known that the prognosis for patients with pancreatic cancer and brain metastasis is very poor. Surgical resection of brain metastasis may play a limited role or may allow long-term survival in patients for whom the primary pancreatic cancer is well controlled. We present a case of brain metastasis in patient with pancreatic cancer after pylorus-preserving pancreaticoduodenectomy and complete response to chemotherapy for hepatic metastases. Brain metastasis was resected successfully, but survival period was relatively short, even though the patient received curative treatment for pancreatic cancer. This case demonstrated that resection of brain metastatic lesion from pancreatic cancer being controlled may be helpful, but the timing of resection is also important.
Brain* ; Diagnosis ; Drug Therapy ; Humans ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Prognosis

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disease. The theories of can-alolthiasis and cupulolithisis of posterior semicircular canal are commonly accepted in BPPV. Recently, not only posterior canal but also lateral canal BPPV were reported. The purposes of this study are to analyze the result of lateral canal BPPV treatment and to introduce effective schedule of reposition maneuvers and follow up. MATERIALS AND METHODS: Sixty two patients who were diagnosed as lateral semicircular canal BPPV were included in this study. Supine head turning test was done and eye movement was documented with videonystagmography. In the canalolithiasis type, barbecue rotation maneuver was performed and in the cupulolithiasis type, cupulolith reposition maneuver was performed. In each type of BPPV, we analyzed the number of treatment until nystagmus was disappeared, recurrence rate and relationship between recurrence and age, sex of patients. RESULTS: Canalolithiasis type was 55% and cupulolithiasis type was 37%. Eight percents of patients showed combined type. All except 2 cases (congenital malformation) were healed by the reposition maneuver. Vertigo recurred in about 30% of patients, and they were retreated with the reposition maneuver. There was no correlation between recurrence and age, sex of patients. CONCLUSION: In lateral semicircular canal BPPV, the reposition maneuver was a effective treatment method. The reposition maneuver was recommended to perform continuously once a day until nystagmus disappeared. Because recurrence rate was about 30%, continuous follow-up was needed.
Appointments and Schedules ; Eye Movements ; Follow-Up Studies ; Head ; Humans ; Recurrence ; Semicircular Canals* ; Vertigo ; Vestibular Diseases

Tonsillectomy is one of the most common procedures performed by an otorhinolaryngologist. Postoperative hemorrhage and dehydration are two of the most common complications, but glossopharyngeal neuralgia is an unusual complication encountered in tonsillectomy. Glossopharyngeal neuralgia is characterized by paroxysms of ipsilateral and severe lancinating pain occurring in the distribution of the nerve. The pain may be spontaneous or precipitated by a variety of actions that stimulate the region supplied by the glossopharyngeal nerve namely yawning, coughing, swallowing and talking. The proximity between the glossopharyngeal nerve and the tonsillar fossa suggests that dissection in the correct surgical plane during tonsillectomy is important for avoiding injury to the glossopharyngeal nerve. Glossopharyngeal neuralgia after tonsillectomy is induced by intraoperative cauterization, nerve compression or iatrogenic trauma. Management of glossopharyngeal neuralgia induced by tonsillectomy should be given a trial of anti-convulsant medication like carbamazepine or glossopharyngeal nerve resection. A case of glossopharyngeal neuralgia caused by tonsillectomy was experienced by a 29-year-old man, and this case was reported and its aetiology was discussed.
Adult ; Carbamazepine ; Cautery ; Cough ; Deglutition ; Dehydration ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Humans ; Postoperative Hemorrhage ; Tonsillectomy* ; Yawning

BACKGROUND AND OBJECTIVES: The newly developed 2-dimensional ultrasound speckle tracking imaging (2D-STI) has enabled researchers to assess the changes of left ventricular (LV) rotation and torsion. The aims of the present study are to establish normal values and to examine the effect of advancing age on left ventricular torsion. SUBJECTS AND METHODS: We enrolled 182 healthy persons in this study. After examined the standard clinical echocardiographic parameters, we obtained the degree of the LV rotation at the basal and apical levels of the short axis view with using a customized software program EchoPAC, GE. RESULTS: Among the 182 healthy subjects, 109 healthy subjects were finally included (49 males and 60 females) due to the failure of obtaining reliable rotational patterns (feasibility: 59.8%). The basal and apical peak LV rotations during systole were 8.14+/-3.55 degrees and 8.48+/-3.70 degrees, respectively. The basal peak LV rotation and peak LV torsion had a tendency to increase with aging (r=0.277, p=0.004 and r=0.253, p=0.008, respectively). All the values of the basal LV rotation during systole tended to increase with aging. The apical LV rotation had no relationship with aging throughout the entire cardiac cycle. CONCLUSION: 2D-STI was a feasible methodology to measure the LV rotation. The peak LV torsion during systole shows statistically significant augmentation with advancing age, and this is mainly due to the increased basal LV rotation.
Age Factors ; Aging ; Axis, Cervical Vertebra ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Male ; Reference Values ; Systole ; Track and Field

BACKGROUND/AIMS: Increased left atrial (LA) size has been proposed as a predictor of poor cardiovascular outcome in the elderly. In the present study, we evaluated the relationship between LA size and stroke in subjects of all ages who presented with preserved left ventricular systolic function (LVSF) and sinus rhythm (SR), and investigated the relationships between LA size and other echocardiographic parameters of diastolic function. METHODS: A total of 472 subjects were enrolled in the study (161 men, 311 women) and divided into the stroke group (n=75) and control group (n=397). A conventional echocardiographic study was then performed. Subjects with valvular heart disease, atrial fibrillation, or coronary heart disease were excluded. RESULTS: The mean subject age was 65.2+/-5.1 years in the stroke group and 65.6+/-5.9 years in the control group. Mitral inflow pattern and E & A velocity showed no significant relationship with stroke (p=NS, p=NS, respectively). Left ventricular mass index and LA dimension were significantly related to stroke (p=0.003, p=0.023, respectively), and hypertension showed a marginal relationship with stroke (p=0.050). Age was not related to stroke in the present study (p=NS). CONCLUSIONS: The LA dimension is significantly related to the incidence of stroke. Therefore, strategies for prevention of stroke in patients with preserved LVSF and SR should be considered in cases of LA enlargement.
Adult ; Aged ; Echocardiography, Doppler, Pulsed ; Female ; Heart Atria/*ultrasonography ; Heart Rate/*physiology ; Heart Ventricles/physiopathology/ultrasonography ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Contraction/*physiology ; Retrospective Studies ; Risk Factors ; Stroke/*epidemiology/etiology ; Stroke Volume/*physiology ; Systole ; Ventricular Function, Left/*physiology

Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

BACKGROUND AND OBJECTIVES: The renin-angiotensin system (RAS) genes have been studied extensively as etiologic essential hypertension (EH) candidate genes in human populations worldwide. The angiotensin I-converting enzyme (ACE) plays an important role in the RAS for the regulation of blood pressure. Recent reports on the association of ACE gene polymorphisms with EH and the related cardiovascular diseases have been controversial. Therefore, this study investigated the association of three polymorphisms (I/D, G14480C and A22982G) in the ACE gene with EH in Koreans. SUBJECTS AND METHODS: This study recruited a sample population of 887 Koreans (comprising of 461 controls and 426 EH cases) from Cardiovascular Genome Center in Korea. The ACE gene polymorphisms were determined by a polymerase chain reaction and a SNP-IT assay. RESULTS: The genotype and the allele frequencies of all three polymorphisms in the hypertensives and the normotensives not significantly different (p>0.05). In the female control group, there was a significant difference in SBP among the genotype with the I/D polymorphism (p<0.05). There was also an association between the ACE polymorphisms and the hypertensive male group with the total cholesterol level. Haplotype analysis showed that none of the haplotypes were significantly associated with hypertension. CONCLUSION: ACE polymorphisms do not appear to have any apparent association with essential hypertension in Koreans, who have a more homogeneous genetic structure than other ethnic groups.
Asian Continental Ancestry Group ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Ethnic Groups ; Female ; Gene Frequency ; Genetic Structures ; Genome ; Genotype ; Haplotypes ; Humans ; Hypertension* ; Korea ; Male ; Peptidyl-Dipeptidase A ; Polymerase Chain Reaction ; Renin-Angiotensin System

Congenital left atrial appendage aneurysm is a very rare congenital cardiac abnormality. That is postulated to arise from a developmental weakness in the atrial wall in utero. Clinically, patients are often asymptomatic and are diagnosed incidentally, but supraventricular arrhythmias and systemic thromboembolism have also been reported in some cases. Surgical resection at the time of diagnosis is recommended because of the propensity for thromboembolic complications. A 13-month-old female, who was suspected preoperatively as having partial absence of pericardium with left atrial herniation through the defect, underwent surgical resection of the left atrial appendage aneurysm. Exposure through a median sternotomy showed an intact pericardium. The postoperative course was uneventful.
Aneurysm* ; Arrhythmias, Cardiac ; Atrial Appendage* ; Diagnosis ; Female ; Humans ; Infant ; Pericardium ; Sternotomy ; Thromboembolism