OBJECTIVE: Fall is one of major causes of morbidity and mortality in the elderly. It is known that sleep is associated with quality of life in the elderly. Snoring is one of the factors affecting sleep quality. The aim of the study was to examine whether snoring affect fall in the community elderly. METHODS: This survey was performed as a part of the Korean Social Life, Health, and Aging Project, which studied the elderly living in Ganghwa-gun. Fall was defined as any history of fall in the last year through face-to-face interview. We examined the following variables: age, sex, snoring, insomnia, hypertension, diabetes, stroke, bone disease, vision problems, depression, alcohol intake, mini-mental state examination, and body mass index. The data was analyzed by multiple logistic regression to determine the association of fall with the risk factors. RESULTS: In the multivariate analysis of 516 participants, the adjusted odd ratios (95% confidence interval) of simple snoring affecting fall was 1.70 (1.10–2.63). In addition, sex (female), age, and diabetes were significantly predicted the fall. CONCLUSION: Our result suggested that snoring could be a risk factor of fall. A more comprehensive study of the relationship between snoring and fall is needed to improve the quality of life of the community elderly.
Aged* ; Aging ; Body Mass Index ; Bone Diseases ; Depression ; Humans ; Hypertension ; Logistic Models ; Mortality ; Multivariate Analysis ; Quality of Life ; Risk Factors* ; Sleep Initiation and Maintenance Disorders ; Snoring* ; Stroke

BACKGROUND: The use of monitored anesthesia care (MAC) as the technique of choice for a variety of invasive or noninvasive procedures is increasing. The purpose of this study to compare the outcomes of two different methods, spinal anesthesia and ilioinguinal-hypogastric nerve block (IHNB) with target concentrated infusion of remifentanil for inguinal herniorrhaphy. METHODS: Fifty patients were assigned to spinal anesthesia (Group S) or IHNB with MAC group (Group M). In Group M, IHNB was performed and the effect site concentration of remifentanil, starting from 2 ng/ml, was titrated according to the respiratory rate or discomfort, either by increasing or decreasing the dose by 0.3 ng/ml. The groups were compared to assess hemodynamic values, oxygen saturation, bispectral index (BIS), observer assessment alertness/sedation scale (OAA/S), visual analogue scale (VAS) for pain score and patients' and surgeon's satisfaction. RESULTS: BIS and OAA/S were not significantly different between the two groups. Hemodynamic variables were stable in Group M. Thirteen patients in the same group showed decreased respiratory rate without desaturation, and recovered immediately by encouraging taking deep breaths without the use of assist ventilation. Although VAS in the ward was not significantly different between the two groups, interestingly, patients' and surgeon's satisfaction scores (P = 0.0004, P = 0.004) were higher in Group M. The number of the patients who suffered from urinary retention was higher in Group S (P = 0.0021). CONCLUSIONS: IHNB under MAC with remifentanil is a useful method for inguinal herniorrhaphy reflecting hemodynamic stability, fewer side effects and higher satisfaction. This approach can be applied for outpatient surgeries and patients who are unfit for spinal anesthesia or general anesthesia.
Ambulatory Surgical Procedures ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Hemodynamics ; Herniorrhaphy ; Humans ; Nerve Block ; Oxygen ; Piperidines ; Respiratory Rate ; Urinary Retention ; Ventilation

BACKGROUND AND OBJECTIVES: To investigate epidemiological features of patients with sialolithiasis and to evaluate the difference in outcomes depending on its location. SUBJECTS AND METHOD: We included in the test 472 patients, or 534 cases, who were admitted to the Hallym University Sacred Heart Hospital between February 2006 and May 2017 with the diagnosis of sialolithiasis. The diagnosis of sialolithiasis was established by CT images; all of the cases were classified by the location of stones (orifice to stone/orifice to hilum: 0–0.25, type I; 0.25–0.5, type II; 0.5–0.75, type III; 0.75–1, type IV). RESULTS: The average size of stone was 7.2±4.8 mm and the mean patient age was 36.1±17.4 years old. According to the method described above, 534 cases were classified into the following: type I consisted of 188 cases (35.2%), type II consisted of 55 cases (10.2%), type III consisted of 92 cases (17.2%) and type IV consisted of 199 (37.2%). When comparing these types, stones in Type I were significantly smaller than other groups. There was a significant difference in the surgical method depending on the location of stones. Different complications such as swelling, bleeding, tongue discomfort, ranula, recurrence, etc. have been reported and, together, they statistically show meaningful differences in the distribution depending on types. CONCLUSION: The position of stone in Wharton's duct is important factor that can determine the method of surgical procedure or postoperative prognosis. We recommend 4 types classification of sialolithiasis and it can provide more specific diagnosis of disease and facilitate approach for treatment.
Classification ; Diagnosis ; Heart ; Hemorrhage ; Humans ; Methods ; Prognosis ; Ranula ; Recurrence ; Retrospective Studies ; Salivary Ducts ; Salivary Gland Calculi ; Submandibular Gland ; Tongue

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.
Aorta ; Arteries ; Athletes ; Collagen ; Consensus ; Extremities ; Flank Pain ; Humans ; Iliac Artery ; Male ; Middle Aged ; Natural History ; Stents ; Vascular Diseases

Extracranial carotid artery aneurysm is an uncommon disease that otorhinolaryngologists may encounter only rarely. It usually presents as pulsatile neck mass or as other neurologic symptoms. We report a case of extracranial internal carotid artery aneurysm in an 81-year old female who presented with a fever and nonpulsatile oropharyngeal swelling mimicking a peritonsillar abscess. Incision and drainage of the swelling lesion could have resulted in catastrophic events such as aneurismal rupture or a stroke. We thus recommend radiologic evaluations of peritonsillar abscess before performing any procedure, even if it is clinically highly suspicious.

BACKGROUND AND OBJECTIVES: To investigate epidemiological features of patients with sialolithiasis and to evaluate the difference in outcomes depending on its location.SUBJECTS AND METHOD: We included in the test 472 patients, or 534 cases, who were admitted to the Hallym University Sacred Heart Hospital between February 2006 and May 2017 with the diagnosis of sialolithiasis. The diagnosis of sialolithiasis was established by CT images; all of the cases were classified by the location of stones (orifice to stone/orifice to hilum: 0–0.25, type I; 0.25–0.5, type II; 0.5–0.75, type III; 0.75–1, type IV). RESULTS: The average size of stone was 7.2±4.8 mm and the mean patient age was 36.1±17.4 years old. According to the method described above, 534 cases were classified into the following: type I consisted of 188 cases (35.2%), type II consisted of 55 cases (10.2%), type III consisted of 92 cases (17.2%) and type IV consisted of 199 (37.2%). When comparing these types, stones in Type I were significantly smaller than other groups. There was a significant difference in the surgical method depending on the location of stones. Different complications such as swelling, bleeding, tongue discomfort, ranula, recurrence, etc. have been reported and, together, they statistically show meaningful differences in the distribution depending on types. CONCLUSION The position of stone in Wharton's duct is important factor that can determine the method of surgical procedure or postoperative prognosis. We recommend 4 types classification of sialolithiasis and it can provide more specific diagnosis of disease and facilitate approach for treatment.

Background: Replacement drivers represent a significant portion of platform labor in the Republic of Korea, often facing night shifts and the demands of emotional labor. Research on replacement drivers is limited due to their widespread nature. This study examined the levels of presenteeism and absenteeism among replacement drivers in comparison to those of paid male workers in the Republic of Korea. Methods: This study collected data for replacement drivers and used data from the 6th Korean Working Conditions Survey for paid male workers over the age of 20 years. Propensity score matching was performed to balance the differences between paid workers and replacement drivers. Multivariable logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals for presenteeism and absenteeism by replacement drivers. Stratified analysis was conducted for age groups, educational levels, income levels, and working hours. The analysis was adjusted for variables including age, education, income, working hours, working days per week, and working duration. Results: Among the 1,417 participants, the prevalence of presenteeism and absenteeism among replacement drivers was 53.6% (n = 210) and 51.3% (n = 201), respectively. The association of presenteeism and absenteeism (adjusted OR [95% CI] = 8.42 [6.36−11.16] and 20.80 [95% CI = 14.60−29.62], respectively) with replacement drivers being significant, with a prominent association among the young age group, high educational, and medium income levels. Conclusion The results demonstrated that replacement drivers were more significantly associated with presenteeism and absenteeism than paid workers. Further studies are necessary to establish a strategy to decrease the risk factors among replacement drivers.

OBJECTIVE: This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.METHODS: Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.RESULTS: Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.CONCLUSION: Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.
Angiography ; Brain Death ; Brain ; Cerebral Arteries ; Cerebral Veins ; Heart Arrest ; Humans ; Hypothermia ; ROC Curve ; Sensitivity and Specificity

Background: This study assessed the relationship between non-participation in health checkups and all-cause mortality and morbidity, considering socioeconomic status. Methods: Healthy, middle-aged (35–54 years) working individuals who maintained either self-employed or employee status from 2006–2010 were recruited in this retrospective cohort study from the National Health Insurance Service in Korea. Health check-up participation was calculated as the sum of the number of health check-ups in 2007–2008 and 2009–2010.Adjusted hazard ratio (HR) and 95% confidence interval (CI) of all-cause mortality were estimated for each gender using multivariable Cox proportional hazard models, adjusting for age, income, residential area, and employment status. Interaction of non-participation in health check-ups and employment status on the risk of all-cause mortality was further analyzed. Results: Among 4,267,243 individuals with a median 12-year follow-up (median age, 44;men, 74.43%), 89,030 (2.09%) died. The proportion (number) of deaths of individuals with no, one-time, and two-time participation in health check-ups was 3.53% (n = 47,496), 1.66% (n = 13,835), and 1.33% (n = 27,699), respectively. The association between health checkup participation and all-cause mortality showed a reverse J-shaped curve with the highest adjusted HR (95% CI) of 1.575 (1.541–1.611) and 1.718 (1.628–1.813) for men and women who did not attend any health check-ups, respectively. According to the interaction analysis, both genders showed significant additive and multiplicative interaction, with more pronounced additive interaction among women who did not attend health check-ups (relative excess risk due to interaction, 1.014 [0.871−1.158]). Conclusion Our study highlights the significant reverse J-shaped association between health check-up participation and all-cause mortality. A pronounced association was found among self-employed individuals, regardless of gender.