PURPOSE: Inferior oblique palsy is the least commonly isolated extraocular muscle palsy. We describe the clinical features and managements of 2 cases of traumatic inferior oblique palsy. METHODS: Two adult patients were presented with vertical diplopia and head tilt posture after head trauma. The subjects fulfilled the three-step test criteria, with a hypertropia that worsened on side gaze and head tilt away from the affected eye. They showed free forced duction to elevation in adduction. Both were treated by ipsilateral superior oblique tenotomy and contralateral superior rectus recession with adjustable suture technique. RESULTS: During postoperative 7 month observation, both patients demonstrated orthophoria in primary gaze. Our surgical procedures eliminated the diplopia and abnormal head tilt posture, thereby achieving satisfactory results.
Adult ; Craniocerebral Trauma ; Diplopia ; Head ; Humans ; Paralysis* ; Posture ; Strabismus ; Suture Techniques ; Tenotomy

PURPOSE: The authors studied the results of excimer laser in situ keratomileusis for correction of myopic astigmatism. METHODS: The authors studied the results of 108 eyes(83 patients) who underwent excimer laser in situ keratomileusis for correction of myopic astigmatism and had preoperative atigmatism greater than 0.5 diopter(D). Each patient had been followed up for over 12 months since January 1996. Refractive errors, uncorrected visual acuity(UVA) and best corrected visual acuity(BCVA) were measured at postoperative 1, 3, 6 months and 1 year, respectively. And astigmatic changes were analyzed by vector analysis using the Holladay formula. RESULTS: Twenty-five patients were male; 58 were female. Mean spherical equivalent was -11.64 D +/-4.03 D preoperatively and -1.32 D+/-1.73 D at postoperative 1 year. In group I(31 eyes:0.50 D~0.75 D),II(46 eyes:1.00 D~1.75 D), III(15 eyes:2.00 D~2.75 D), IV(16 eyes:3.00 D~6.50 D), postoperative astigmatism were 0.60+/-0.73 D, 0.58+/-0.72 D, 0.75+/-0.89 D, 0.62+/-0.60 D at ostoperative 1 year. In 17.2% of all the eyes, axis deviation within 30 degrees was noted 1 year after the surgery. By vector analysis, astigmatic errors were corrected within 0.50 D of the attempted amount in 64.5% of group I, 63.0% of group II, 56.0% of group III and 66.7% of group IV. UVA was 0.5 or better in 69%, and 0.8 or better in 46% at postoperative 1 year. CONCLUSIONS: BCVA did not change after the surgery in most of the eyes. The greater the amount of preoperative astigmatism, the more effective the postoperative astigmatic correction
Astigmatism ; Axis, Cervical Vertebra ; Female ; Humans ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Male ; Refractive Errors ; Visual Acuity

No abstract available.
Parkinsonian Disorders*

BACKGROUND: Quality-of-life measurement represents an important tool for evaluating the management and impact of headache on individuals and society. The Headache Impact Test-6 (HIT-6) is a simple instrument developed to assess headache-related disability in Western countries. The objective of this study was to determine the reliability and validity of the Korean HIT-6. METHODS: Participants were recruited from patients who visited the Neurology Clinic of Hallym University Sacred Heart Hospital due to headache. The survey included the SF-36 and HIT-6. Headache diagnosis was assigned using ICHD-II after completing a semistructured diagnostic interview. RESULTS: A total of 43 patients were recruited, who were aged 35.2+/-13.6 years (mean+/-SD). Thirty-three and three were diagnosed as having migraine and probable migraine, respectively. Eight and two were diagnosed with tension-type and probable tension-type headache, respectively. There was a negative correlation between the total SF-36 and HIT-6 scores (Spearman's correlation coefficient=-0.64, p<0.01). Similar significant negative correlations were also observed between SF-36 physical health summary and HIT-6 scores (Spearman's correlation coefficient=-0.54, p<0.01), and between SF-36 mental summary and HIT-6 scores (Spearman's correlation coefficient=-0.60, p<0.01). The Cronbach's alpha of HIT-6 was 0.85. CONCLUSIONS: The Korean HIT-6 is a valid and reliable instrument for assessing headache-related quality of life.
Aged ; Headache ; Heart ; Humans ; Migraine Disorders ; Neurology ; Quality of Life ; Reproducibility of Results ; Tension-Type Headache

Acute pulmonary embolism is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Tumor embolism is a rare and unique complication of malignancies, and detached thrombi or tumors may cause massive pulmonary embolism in patients with malignancies. The identification of the type of pulmonary embolism is critical because treatment and prognosis vary considerably. We report an unusual presentation of a tumor embolism that was misdiagnosed as a pulmonary thromboembolism in a young woman. The patient was initially treated with the anti-coagulants warfarin and aspirin, but her symptoms were aggravated after two months and she required emergency surgery. Histology revealed a pulmonary embolism due to metastatic chondrosarcoma. Following surgery, her condition deteriorated, and she did not survive. This case highlights the need to investigate the cause of pulmonary embolism should the patient not respond to anti-coagulatant therapy.
Aspirin ; Chondrosarcoma ; Emergencies ; Female ; Humans ; Neoplasm Metastasis ; Neoplastic Cells, Circulating ; Prognosis ; Pulmonary Embolism ; Warfarin

Myoclonus manifests in a variety of situations including epilepsy, metabolic derangements, brain lesions, and toxicity of drugs. A 57-year-old woman with end-stage renal disease was given gabapentin 900 mg/day for legs' paresthesia. Two days after taking gabapentin, multifocal myoclonus developed involving all extremities. Three days after discontinuation of gabapentin, myoclonus resolved completely. No deterioration of renal function was noted before and after the occurrence of myoclonus. Administration of gabapentin should be performed with caution in patients with impaired renal function.
Brain ; Epilepsy ; Extremities ; Female ; Humans ; Kidney Failure, Chronic* ; Middle Aged ; Myoclonus* ; Paresthesia

BACKGROUND: Migraine can cause suffering and reduce functioning and productivity. Migraine is usually suboptimally treated, with many migraineurs not being satisfied with the applied acute treatment. Migraine-ACT is a four-item assessment tool used by clinicians to identify patients who require a change in their acute treatment. The objective of this study was to determine validity and reliability of the Korean Migraine-ACT. METHODS: Participants who visited Hallym University Sacred Heart Hospital neurology clinic for headache were recruited. The survey employed SF-36, HIT-6, and Migraine-ACT. Headache diagnosis was assigned on ICHD-II after completing a semistructured diagnostic interview. RESULTS: A total of 52 migraine patients aged 38.7+/-14.7 years (mean+/-SD) were recruited. There was a positive correlation between general summary scores on SF-36 and Migraine-ACT (Spearman's correlation coefficient=0.39, p<0.05) and a negative correlation between HIT-6 scores and Migraine-ACT scores (Spearman's correlation coefficient=.0.52, p<0.05). Cronbach's alpha of Migraine-ACT was 0.78. CONCLUSIONS: These results indicate that Korean Migraine-ACT is a valid and reliable instrument to identify migraine patients who require a change in their acute treatment.
Aged ; Efficiency ; Headache ; Heart ; Humans ; Migraine Disorders ; Neurology ; Reproducibility of Results ; Stress, Psychological

Background: As the genetic variants of trabecular bone microarchitecture are not well-understood, we performed a genome-wide association study to identify genetic determinants of bone microarchitecture analyzed by trabecular bone score (TBS). Methods: TBS-associated genes were discovered in the Ansung cohort (discovery cohort), a community-based rural cohort in Korea, and then validated in the Gene-Environment Interaction and Phenotype (GENIE) cohort (validation cohort), consisting of subjects who underwent health check-up programs. In the discovery cohort, 2,451 participants were investigated for 1.42 million genotyped and imputed markers. Results: In the validation cohort, identified as significant variants were evaluated in 2,733 participants. An intronic variant in iroquois homeobox 3 (IRX3), rs1815994, was significantly associated with TBS in men (P=3.74E-05 in the discovery cohort, P=0.027 in the validation cohort). Another intronic variant in mitogen-activated protein kinase kinase 5 (MAP2K5), rs11630730, was significantly associated with TBS in women (P=3.05E-09 in the discovery cohort, P=0.041 in the validation cohort). Men with the rs1815994 variant and women with the rs11630730 variant had lower TBS and lumbar spine bone mineral density. The detrimental effects of the rs1815994 variant in men and rs11630730 variant in women were also identified in association analysis (β=–0.0281, β=–0.0465, respectively). Conclusion In this study, the rs1815994 near IRX3 in men and rs11630730 near MAP2K5 in women were associated with deterioration of the bone microarchitecture. It is the first study to determine the association of genetic variants with TBS. Further studies are needed to confirm our findings and identify additional variants contributing to the trabecular bone microarchitecture.

OBJECTIVES: Lifestyles, including exercise behaviors, change continually over time. This study examined whether the clinical biomarkers (CBs) related to cardiometabolic diseases (CMDs) and their relationships differed with changes in exercise behavior. METHODS: The Ansan-Ansung cohort study (third to fifth phases; n=2,668) was used in the current study. Regular exercise behavior was investigated using a yeso questionnaire. Changes in exercise behavior were classified into 4 groups: Y-N, N-Y, Y-Y, and N-N, with “Y” indicating that a participant regularly engaged in exercise at a given time point and “N” indicating that he or she did not. Fourteen CBs related to CMDs were used, and the associations between changes in exercise behavior and relative changes in CBs were examined. CB networks were constructed and topological comparisons were conducted. RESULTS: Y-N was associated with increases in fasting blood sugar and insulin levels in men, and increased total cholesterol and low-density lipoprotein cholesterol levels in women. Meanwhile, N-Y was inversely associated with body fat percentage, visceral fat percentage, fasting insulin, and triglyceride level. Waist circumference played a central role in most networks. In men, more edges were found in the N-Y and Y-Y groups than in the N-N and Y-N groups, whereas women in the N-Y and Y-Y groups had more edges than those in the N-N and Y-N groups. CONCLUSIONS Consistent exercise or starting to engage in regular exercise had favorable effects on CBs related to CMDs, although their network patterns differed between the sexes.

PURPOSE: The high mobility group box 1 (HMGB1) protein has roles in apoptosis and immune responses by acting as a ligand for receptor for advanced glycation end products (RAGE), Toll-like receptors (TLRs), and triggering receptor expressed on myeloid cells 1. In particular, HMGB1/RAGE is involved in tumor metastasis by inducing matrix metalloproteinase 2 (MMP2) and MMP9 expression. We investigated the associations between genetic variations in HMGB1-related genes and disease-free survival (DFS) and overall survival (OS) in Korean female breast cancer patients. METHODS: A total of 2,027 patients in the Seoul Breast Cancer Study were included in the analysis. One hundred sixteen single nucleotide polymorphisms (SNPs) were extracted from eight genes. A multivariate Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval (CI) of each SNP. The effects of the SNPs on breast cancer prognosis were assessed at cumulative levels with polygenic risk scores. RESULTS: The SNPs significantly associated with DFS were rs243867 (hazard ratio, 1.26; 95% CI, 1.05–1.50) and rs243842 (hazard ratio, 1.24; 95% CI, 1.03–1.50); both SNPs were in MMP2. The SNPs significantly associated with OS were rs243842 in MMP2 (hazard ratio, 1.33; 95% CI 1.03–1.71), rs4145277 in HMGB1 (hazard ratio, 1.29; 95% CI, 1.00–1.66), rs7656411 in TLR2 (hazard ratio, 0.76; 95% CI, 0.60–0.98), and rs7045953 in TLR4 (hazard ratio, 0.50; 95% CI, 0.29–0.84). The polygenic risk score results for the DFS and OS patients showed third tertile hazard ratios of 1.72 (95% CI, 1.27–2.34) and 2.75 (95% CI, 1.79–4.23), respectively, over their first tertile references. CONCLUSION: The results of the present study indicate that genetic polymorphisms in HMGB1-related genes are related to breast cancer prognosis in Korean women.
Advanced Glycosylation End Product-Specific Receptor ; Apoptosis ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Female ; Genetic Predisposition to Disease* ; Genetic Variation ; HMGB1 Protein ; Humans ; Matrix Metalloproteinase 2 ; Myeloid Cells ; Neoplasm Metastasis ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prognosis* ; Proportional Hazards Models ; Seoul ; Toll-Like Receptors