BACKGROUND: It is well known that there is wide individual variation of responsiveness when parasympathetic nervous system is stimulated physiologically, pathologically, and therapeutically. But no appropriate explanation is present for that yet. So the purpose of this study is to verify individual diversity of vagal tone during resting state and after vagal stimulation and to find factor that may significantly contribute to it. METHOD: We serially measured variation of heart period(VHP : sec) which had been known to be an accurate index of cardiac parasympathetic tone during resting state(VHPb) and after vagal stimulation by ice water application to face(VHPv). And we analyzed correlation between VHPb, VHPv and ratio of VHPv to VHPb(ratio). RESULT: There was wide variation of vagal tone both in resting state (VHPb : 0.025-0.161) and after vagal stimulation (VHPv : 0.087-0.661). VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb<0.07, B : 0.07-0.1, C : >0.1). The low VHPb group A showed dramatic increase in vagal tone after vagal stimulation (ratio 2.21-20.24 mean 7.7), on the other hand high VHPb group C did not (ratio 0.80-2.55 mean 1.39). There ws also a significant negative correlation between VHPb and ratio (r=0.69, p<0.001). CONCLUSION: These results suggest that there is wide individual diversity of responsiveness to vagal stimulation and magnitude of vagal tone in resting state is an important factor to determine the responsiveness to vagal stimulation.
Child* ; Hand ; Heart ; Humans ; Ice ; Parasympathetic Nervous System ; Water

Multiple primary cancer is defined as the case of primary malignant tumors of different histologic origins each other in one person, The incidence of multiple primary cancer has been increasing recently due to more developed diagnostie procedure and long survival of cancer patients. In esophageal cancer patients, comibined prevalence of other malignancy is rela tively high. We have experienced three cases of gastric adenocarcinoma with esophageal squamous cell carcinoma and report these cases with a review of literatures.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Esophagus* ; Humans ; Incidence ; Prevalence ; Stomach*

PURPOSE: The purpose of this study was to assess the hard and soft tissue changes associated with mandibular bilateral sagittal split osteotomy and genioplasty. METHODS: This is a retrospective study of 40 patients who underwent either bilateral sagittal split osteotomy for mandibular setback (BSSO group, n = 20) or in combination with advancement genioplasty (Genio group, n = 20). Lateral radiographs, were taken before and immediately after surgery, and at least 6 months after surgery. RESULTS: Comparing hard and soft tissue changes between the BSSO group and Genio group, there were significant differences in the lower incisor, soft tissue B point (B'), and soft tissue Pogonion (Pg') (p < 0.5). The mean ratio of hard and soft tissue changes for B/B', Pg/Pg', and Menton/soft tissue Menton after surgery in the BSSO group was 0.997, 0.965, and 1.022 respectively, and 0.824, 0.602, and 0.887 respectively in the genio group. Significant differences were found between the two groups. There were significant differences in lip thickness (B-B', Pg-Pg') in the Genioplasty group between pre and postsurgery, but not in the BSSO group. Pogonion to Labrale inferior and B' had a correlation coefficient of 0.833, 0.922, respectively for the BSSO group, and 0.775, 0.799 for the Genio group. CONCLUSIONS: The results indicate that there is a significant difference between bilateral sagittal split osteotomy with or without genioplasty in the lower facial esthetics values. The combination of mandibular setback and genioplasty had a smaller change in soft tissue thickness of the symphysis area after surgery than that of mandibular setback only.
Esthetics ; Genioplasty ; Humans ; Incisor ; Lip ; Osteotomy ; Retrospective Studies ; Sitosterols

Background: As an indicator of electro-mechanical coupling, electromechanical window (EMW) can be used to predict fatal ventricular arrhythmias. We investigated the additive effect of EMW on the prediction of fatal ventricular arrhythmias in high-risk patients. Methods: We included patients who had implantable cardioverter-defibrillator (ICD) implanted for primary or secondary prevention. The event group was defined as those who received an appropriate ICD therapy. We acquired echocardiograms at ICD implantation and follow-up. The EMW was calculated as the difference between the interval from QRS onset to aortic valve closure and QT interval from the electrocardiogram embedded in the continuous wave doppler image. We evaluated the predictive value of EMW for predicting fatal ventricular arrhythmia. Results: Of 245 patients (67.2 ± 12.8 years, 63.7% men), the event group was 20.0%. EMW at baseline (EMW-Baseline) and follow-up (EMW-FU) was significantly different between event and control groups. After adjustment, both EMW-Baseline (odds ratio [OR]adjust 1.02 [1.01– 1.03], P = 0.004) and EMW-FU (ORadjust 1.06 [1.04–1.07], P < 0.001) remained as significant predictors for fatal arrhythmic events. Adding EMW-Baseline significantly improved the discriminating ability of the multivariable model including clinical variables (area under the curve [AUC] 0.77 [0.70–0.84] vs. AUC 0.72 [0.64–0.80], P = 0.004), while a univariable model using EMW-FU alone showed the best performance among models (AUC 0.87 [0.81– 0.94], P = 0.060 against model with clinical variables; P = 0.030 against model with clinical variables and EMW-Baseline). Conclusion The EMW could effectively predict severe ventricular arrhythmia in ICD implanted patients. This finding supports the importance of incorporating the electro-mechanical coupling index into the clinical practice for predicting future fatal arrhythmia events.

Raoultella ornithinolytica (formerly Klebsiella ornithinolytica ) is a Gram-negative aerobic bacillus which belongs to the family Enterobacteriaceae. However, human infections caused by bacteria of the genus Raoultella are uncommon and their pathogenicity is not well known yet. Herein, we report a case of necrotizing fasciitis caused by R. ornithinolytica in a 51 years old female patient who presented with erythematous swelling after a plantar puncture wound from a thumbtack.
Bacillus ; Bacteria ; Enterobacteriaceae ; Fasciitis, Necrotizing ; Female ; Humans ; Klebsiella ; Punctures

OBJECTIVES: Benign conditions have been known to cause an increase in the levels of serum carcinoembryonic antigen, a level change that is often associated with an increase in the occurrence of malignancy. The purpose of this study was to elucidate the relationship between serum CEA levels and type of work in shipyard workers. METHODS: From July-August 2007, 637 study subjects were enrolled into the study with the following characteristics: age 37~58 years, healthy shipyard workers, and who undergone an examination in a general hospital. Data on general characteristics was gathered from self-administered questionnaires. Information on job factors was collected from company personnel data. Serum CEA levels were measured after 10 hours'fasting. RESULTS: The level of mean serum CEA was 1.83+/-1.20 ng/mL. On univariate analysis, the mean CEA level was significantly higher in older age groups (P<0.05), current smokers, lower education, and in production workers (P<0.01). After adjusting for age, BMI, cigarette smoking, job pattern, and educational level, the serum CEA level was higher in production workers than in office workers(P<0.01). This is particularly true in the shipyard painters, who had the highest level of CEA across job groups. CONCLUSIONS: The goal of this was to determine if there were differences in serum CEA levels according to occupational role in shipyard workers. Production shipyard workers had relatively higher level of serum CEA than office workers, most likely due to occupational exposure. This serum CEA level is influenced by occupation role. Serum CEA level could be a parameter for evaluating pollutant effects.
Carcinoembryonic Antigen ; Hospitals, General ; Humans ; Occupational Exposure ; Occupations ; Questionnaires ; Smoking

beta -Blockers can cause bronchospasm in asthma. beta 2-agonists prolong the QT interval and alter the clinical course of long QT syndrome (LQTS). We report a case of asthma exacerbation treated cautiously with beta 2-agonists in a patient with LQTS, while LQTS was controlled with low-dose beta 1-antagonists. A 31-year-old woman with LQTS visited the emergency room for asthma exacerbation. FEV1 was 0.5 L (18%) and QTc interval was 520 ms. Low doses of salbutamol or salmeterol were used and gradually increased, while monitoring the QT interval. Simultaneously, a low dose of atenolol was maintained. FEV1 was increased to 2.2 L (83%) without further QT prolongation or cardiac events. The case suggests that lower doses of beta 1-antagonists can be tried for cardiac diseases, even in the presence of asthma exacerbations. beta 2-Agonists may be initiated at lower doses and, if tolerated, the dose can be increased in asthmatic patients with a risk for QT prolongation.
Adrenergic beta-Agonists ; Adrenergic beta-Antagonists ; Adult ; Albuterol ; Asthma ; Atenolol ; Bronchial Spasm ; Emergencies ; Female ; Heart Diseases ; Humans ; Long QT Syndrome ; Salmeterol Xinafoate

Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.
Colon ; Colonoscopy ; Humans ; Intestinal Perforation ; Ligation

BACKGROUND: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. METHODS: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients' allocation. RESULTS: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). CONCLUSIONS: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Antiemetics ; Humans ; Incidence ; Intubation ; Oxygen* ; Postoperative Nausea and Vomiting* ; Research Personnel ; Vitreoretinal Surgery*

PURPOSE: Label adherence for non-vitamin K antagonist oral anticoagulants (NOACs) has not been well evaluated in Asian patients with non-valvular atrial fibrillation (AF). The present study aimed to assess label adherence for NOACs in a Korean AF population and to determine risk factors of off-label prescriptions of NOACs. MATERIALS AND METHODS: In this COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry, patients with AF who were prescribed NOACs between June 2016 and May 2017 were included. Four NOAC doses were categorized as on- or off-label use according to Korea Food and Drug Regulations. RESULTS: We evaluated 3080 AF patients treated with NOACs (dabigatran 27.2%, rivaroxaban 23.9%, apixaban 36.9%, and edoxaban 12.0%). The mean age was 70.5±9.2 years; 56.0% were men; and the mean CHA₂DS₂-VASc score was 3.3±1.4. Only one-third of the patients (32.7%) was prescribed a standard dose of NOAC. More than one-third of the study population (n=1122, 36.4%) was prescribed an off-label reduced dose of NOAC. Compared to those with an on-label standard dosing, patients with an off-label reduced dose of NOAC were older (≥75 years), women, and had a lower body weight (≤60 kg), renal dysfunction (creatinine clearance ≤50 mL/min), previous stroke, previous bleeding, hypertension, concomitant dronedarone use, and anti-platelet use. CONCLUSION: In real-world practice, more than one-third of patients with NOAC prescriptions received an off-label reduced dose, which could result in an increased risk of stroke. Considering the high risk of stroke in these patients, on-label use of NOAC is recommended.
Anticoagulants ; Asian Continental Ancestry Group ; Atrial Fibrillation ; Body Weight ; Cohort Studies ; Drug and Narcotic Control ; Drug Labeling ; Female ; Hemorrhage ; Humans ; Hypertension ; Korea ; Male ; Off-Label Use ; Prescriptions ; Prospective Studies ; Risk Factors ; Rivaroxaban ; Stroke