OBJECTIVE: The purposes of this study were to evaluate the reproducibility and reliability of head posture obtained by registering outer canthus as a soft tissue landmark with the Outer Canthus Indicator (OCI). METHODS: Twenty-one adults with normal facial morphology were enrolled in this study (mean age 27.5 +/- 1.72 years). To register initial head posture, height of the outer canthus from the ear rod plane was measured using OCI. Head posture was reproduced by moving the head upwards and downwards until the outer canthus was in a straight line with the indicator set at a registered height. After the head posture is reproduced by two operators after two days, lateral photographs were taken. Computerized photometric analyses of the photographs were performed. RESULTS: The head rotations around the transverse axis were 0.69 +/- 0.43degrees, 0.98 +/- 0.65degrees from each of the two operators. Standard errors were 0.09degrees and 0.14degrees each, which were similar to results from past research findings. There were no significant differences between the data from the two operators (p > 0.05). There were no correlations between the head rotation around the horizontal and vertical axes (p > 0.05). CONCLUSIONS: The present study suggests that OCI-registered head posture may minimize errors from vertical head rotation in cephalometry and photometry.
Adult ; Axis, Cervical Vertebra ; Cephalometry ; Ear ; Head ; Humans ; Photometry ; Posture

BACKGROUND: Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. The head-up tilt test (HUTT) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We investigated the association between epicardial fat thickness (EFT) and autonomic neural tone, such as vagal tone. METHODS: A total of 797 consecutive patients (mean age 46.5 years, male: 45.7%) who underwent HUTT and echocardiography between March 2006 and June 2015 were enrolled. EFT was measured during the diastolic phase of the parasternal long axis view. We excluded patients with prior percutaneous coronary intervention, old age (* 70 years old), valvular heart disease, symptomatic arrhythmias and diabetes. We divided patients into two groups based on the HUTT (positive vs. negative). RESULTS: There were 329 patients (41.3%) with a negative HUTT result and 468 patients (58.7%) with a positive result. The HUTT-positive patients showed a significantly lower waist circumference, body mass index and systolic and diastolic blood pressure, although a significantly higher EFT as compared to the HUTT-negative patients (HUTT-positive, 5.69 ± 1.76 mm vs. HUTT-negative, 5.24 ± 1.60 mm; p < 0.001). EFT > 5.4 mm was associated with a positive HUTT result with 51.7% sensitivity and 63.8% specificity (p < 0.001) on receiving operator characteristic analysis. Multivariate Cox regression analysis revealed that EFT (hazard ratio: 1.02, 95% confidence interval: 1.01–1.30, p = 0.004) was an independent predictor of HUTT-positivity. CONCLSION: EFT was significantly correlated with positive HUTT, which suggests an association between EFT and autonomic dysregulation.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Blood Pressure ; Body Mass Index ; Echocardiography ; Heart Valve Diseases ; Humans ; Male ; Percutaneous Coronary Intervention ; Sensitivity and Specificity ; Syncope* ; Syncope, Vasovagal ; Waist Circumference

PURPOSE: Ascending cholangitis is the most common complication after Kasai operations. The aim of this study is to evaluate the therapeutic efficacy of cefotaxime as an empirical antibiotic on ascending cholangitis after Kasai operations. METHODS: Thirty-nine episodes of cholangitis in twenty-nine children who underwent Kasai operations at Seoul National University Children's Hospital from January 1991 to December 2000 were included in this study. Empirical cefotaxime treatments were divided into three groups: cefotaxime and amikacin treatment group(CA group), cefotaxime and gentamicin treatment group(CG group) and cefotaxime treatment group(C group). A diagnosis of cholangitis was made on the basis of unexplained fever(>38degrees C) and either development of acholic stool or elevation of serum total bilirubin (>1.5 mg/dL). Therapeutic efficacy was judged by elimination of fever up to 72 hours, 120 hours, and 168 hours after antibiotic treatment. RESULTS: There were therapeutic responses in 51%(20/39) up to 72 hours after antibiotic treatment : 54%(13/24) in CA group, 43%(3/7) in CG group and 50%(4/8) in C group. There were therapeutic responses in 69%(27/39) up to 120 hours, in 79%(31/39) up to 168 hours and in 82%(32/ 39) up to 2 weeks. There were no differences in therapeutic efficacy among the three regimens. In 12 of 39 episodes, the etiologic pathogens including Escherichia coli and enterococcus were cultured from the blood. CONCLUSION: Cefotaxime can be tried as an initial antibiotic in Korean children with ascending cholangitis after Kasai operation prior to the identification of microorganism on culture. However, further evaluation of pathogen and its resistant strain to cefotaxime should be done.
Amikacin ; Biliary Atresia* ; Bilirubin ; Cefotaxime* ; Child ; Cholangitis* ; Diagnosis ; Enterococcus ; Escherichia coli ; Fever ; Gentamicins ; Humans ; Seoul

BACKGROUND/AIMS: Although postpolypectomy fever (PPF) without colon perforation or hemorrhage is rare, its incidence and risk factors have not been investigated. The objective of this study was to analyze the incidence and risk factors for PPF among inpatients. METHODS: Seven patients with PPF were matched with 70 patients without PPF from a total of 3,444 patients who underwent colonoscopic polypectomy. The PPF incidence during index hospitalization after colonoscopy was calculated, and univariate and multivariate analyses were performed to calculate the adjusted odds ratios (ORs) for risk factors. RESULTS: PPF without bleeding or perforation in the colon occurred in seven patients (0.2%). The median age was 58 years for cases and 61 years for controls. The median interval from polypectomy to occurrence of fever was 7 hours, and the median duration of fever was 9 hours. Polyp size >2 cm (adjusted OR, 1.08; 95% confidence interval [CI], 1.01 to 1.15; p=0.02) and hypertension (adjusted OR, 14.40; 95% CI, 1.23 to 180.87; p=0.03) were associated with a significantly increased risk of PPF. PPF increased the length of hospitalization. CONCLUSIONS: Although the crude incidence of PPF is low, PPF may prolong hospitalization. Risk factors for PPF include hypertension and large polyps.
Case-Control Studies* ; Colon ; Colonoscopy ; Fever* ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Incidence ; Inpatients ; Multivariate Analysis ; Odds Ratio ; Polyps ; Risk Factors

Guillain-Barre syndrome (GBS) is clinically characterized by acute, progressive, symmetrical weakness and areflexia. However there have been several reports of patients with the acute motor axonal neuropathy type of GBS showing hyperreflexia. We experienced a patient with acutely developed ascending progressive weakness of low extremities up to face following enteritis and concomitantly developed hyperreflexia following initial treatment with IVIG. The spinal MRI scan revealed radiological features of acute diffuse myelitis. The treatment with steroid resulted in fairly good clinical and electrophysiological outcome.
Axons ; Enteritis ; Extremities ; Guillain-Barre Syndrome* ; Humans ; Immunoglobulins, Intravenous ; Magnetic Resonance Imaging ; Myelitis* ; Reflex, Abnormal

Coronary embolism is an uncommon cause of myocardial infarction. A 48-year-old male presented with typical chest pain of an MI. There was no definite ST segment change on electrocardiogram (ECG) and no elevation of myocardial enzymes. Coronary angiography (CAG) revealed occlusion of the distal left anterior descending coronary artery (dLAD), the distal left circumflex coronary artery (dLCX), the diagonal branch (D) and the obtuse marginal branch (OM), with a large filling defect in the left main coronary artery (LMA) that caused the myocardial infarction. We considered the possibility that coronary embolization was caused by the migration of a thrombus in the LMA during CAG. We did balloon angioplasty in the dLAD, dLCX, OM and D and treated the patient with glycoprotein IIb/IIIa receptor antagonist. However, thrombi remained in the dLAD, OM, and dLCX. After 3 days of anti-thrombotic treatment, follow-up CAG revealed only slight resolution of thrombi in the LAD. After triple antiplatelet agent medication for 1 year, a follow-up CAG showed a resolution of the thrombi in all coronary arteries.
Angioplasty, Balloon ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Embolism ; Follow-Up Studies ; Glycoproteins ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; Thrombosis

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the mode of injury, associated lesions, time of injury, and the checking times of MRI/CT and Bone scans in multiple spine fractures SUMMARY OF LITERATURE REVIEW: CT was predominantly used to discover and identify the fracture levels of the spine. However, fracture level identification in the entire spine was limited. CT, MRI and Bone scans were used for diagnosing multiple spine fractures. MATERIALS AND METHODS: Between 1999 and 2004, 12 patients who had more than level 3 spine fractures were studied. The mode of injury, associated lesions, time of injury, and checking times of MRI/CT and Bone scans were analyzed. RESULTS: The causes of the spinal injuries were from a fall from height, from traffic accidents and from multi-complex forced trauma in 7, 4 and 1 cases, respectively. Most cases had no severe associated lesions. The accuracy of the plain roentgenograms was 26% and that of CT was 35.3%, and the average checking time was 1.5 days. The accuracy of MRI was 100% and the average checking time was 4.3 days. The accuracy of the bone scans was 100%, and the average checking time was 11.7 days. The fracture patterns consisted of 37, 7, 3 and 3 non-compression (74%), compression (14%), burst (6%) and fracture-dislocation types (6%), respectively. The major treatment methods used with these patients were conservative. The treatment methods in 4 cases were with the use posterior instrumentation. CONCLUSIONS: MRI produced more accurate and faster results than the other methods of detection. The accuracy of the plain roentgenograms was 26%, which was relatively inaccurate. Therefore, if the patient complains of multiple back pains, the surgeon must check other diagnostic tools.
Accidents, Traffic ; Back Pain ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Injuries ; Spine* ; Young Adult*

An imported case of Kala-azar in a 26-year-old Korean man is reported. The diagnosis was made by liver needle biopsy. Amastigotes were seen in Kupffer cells under light microscope, and their characteristic ultrastructural features were recognized under the electron microscope. This case represents an imported disease from Saudi Arabia where the patient spent one year as a construction worker, 8 months before the onset of the disease. This report also signifies the second description of Kala-azar in Korea, and the first case of Kala-azar imported from Saudi Arabia. This patient was successfully treated with sodium antimony gluconate (Pentostam), and follow up liver biopsy showed focal fibrous scar and otherwise normal liver without demonstrable organism.
parasitology ; protozoa ; Kala-azar ; Leishmania donovani ; case report ; Saudi Arabia ; electronmicroscopy

Since an exact ABO blood type match is essential for transfusion therapy, any ABO discrepancies should be resolved prior to the issuing of blood. The authors confirmed the ABO blood group of a 50-year-old male using genotyping. On a routine blood group test, the cell type was A+; however, anti-B was undetected in his serum. To determine the cause of this ABO discrepancy, an adsorption elution test and saliva test were performed. The presence of a weak B substance was suspected despite no evidence of the B antigen on red blood cells. Polymerase-chain-reaction restriction-fragment-length-polymorphism (PCR-RFLP) and sequencing analysis of exons 6 and 7 demonstrated that his blood type was A1Bweak (the A allele tested as the A105 subtype, while the B allele was most similar to the B302 subtype). Again, using genotyping, we subsequently confirmed the A1Bweak blood type in a leukemic patient who was in complete remission.
Adsorption ; Alleles ; Erythrocytes ; Exons ; Humans ; Leukemia ; Male ; Middle Aged ; Saliva

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; C-Reactive Protein ; Enalapril ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Peptidyl-Dipeptidase A ; Plasma ; Prospective Studies ; Renin-Angiotensin System ; Stroke Volume ; Tetrazoles ; Valine ; Valsartan