Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.
Brain Neoplasms ; Dermoid Cyst* ; Diagnosis ; Foramen Ovale* ; Magnetic Resonance Imaging* ; Meningitis ; Prognosis

BACKGROUND/AIMS: Mesenteric microvascular thrombosis has been implicated as a contributing factor to the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to assess the possibility of subclinical atherosclerosis in patients with IBD by measuring their carotid intima-media thickness (c-IMT). METHODS: Thirty-eight patients with IBD who were followed-up for at least 3 years participated. Patients with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded. As a control group, 38 healthy patients matched for age and gender without atherosclerosis risk factors were included. Carotid ultrasonography was performed in all patients and controls. Patient baseline characteristics and laboratory parameters were recorded to evaluate atherosclerosis risk factors. RESULTS: The mean age of patients with IBD was 38.5+/-6.62 years. Twenty-three patients with IBD were diagnosed with ulcerative colitis and the other 15 cases were diagnosed with Crohn's disease. The median duration of disease was 52.0 months. Serologic markers such as erythrocyte sedimentation rate, C-reactive protein (CRP), and cholesterol levels differed significantly, however, there was no significant difference in c-IMT between patients with IBD and those in the control group (0.53+/-0.10 mm vs. 0.53+/-0.07; P=0.85). Multivariate analysis revealed that body mass index, CRP, disease duration, and age were significantly correlated with c-IMT in patients with IBD. CONCLUSIONS: The results of the current study did not show an increase in c-IMT in patients with IBD. Further studies that include more subjects and a longer follow-up period will be necessary in order to evaluate the risk of atherosclerosis in Korean patients with IBD.
Atherosclerosis ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Intima-Media Thickness* ; Cholesterol ; Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Multivariate Analysis ; Risk Factors ; Thrombosis ; Ultrasonography

Suppressing the verbal expression of anger is related to increased pain severity. We investigated the relationship between the pain and anger using a questionnaire in patients with back or neck pain. From August 2007 to January 2008, 173 patients visited our hospital due to back and/or neck pain. They answered the questionnaire before physical examination by themselves. Visual analog scale(VAS) was used to measure the intensity of the pain. The same method was used to measure the intensity and frequency of the anger. We also asked the degree of sleep disturbance, fatigue, loss of appetite, and mood. Psychological disturbances were relatively common; moderate to severe sleep disturbance in 66%, fatigue in 79%, loss of appetite in 55%, and depressed mood in 86%. More than a half answered their anger was moderate to severe in both frequency and degree. All psychological factors appeared to be strong contributors to the intensity of pain by a linear regression analysis. More than a half of the patients with back or neck pain have significant psychological problems. Proper evaluation and management of those psychological factors are important.
Anger ; Appetite ; Back Pain ; Fatigue ; Humans ; Linear Models ; Neck ; Neck Pain ; Physical Examination ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study was to assess the microbiological quality of unchlorinated drinking water in Korea, 2010. One hundred and eighty unchlorinated drinking water samples were collected from various sites in Seoul and Gyeonggi province. METHODS: To investigate bacterial presence, the pour plate method was used with cultures grown on selective media for total bacteria, total coliforms, and Staphylococcus spp., respectively. RESULTS: In the 180 total bacteria investigation, 72 samples from Seoul and 33 samples from Gyeonggi province were of an unacceptable quality (>10(2) CFU/mL). Of all the samples tested, total coliforms were detected in 28 samples (15.6%) and Staphylococcus spp. in 12 samples (6.7%). Most of the coliform isolates exhibited high-level resistance to cefazolin (88.2%), cefonicid (64.7%) and ceftazidime (20.6%). In addition, Staphylococcus spp. isolates exhibited high-level resistance to mupirocin (42%). Species of Pseudomonas, Acinetobacter, Cupriavidus, Hafnia, Rahnella, Serratia, and Yersinia were isolated from the water samples. CONCLUSIONS: The results of this study suggest that consumption of unchlorinated drinking water could represent a notable risk to the health of consumers. As such, there is need for continuous monitoring of these water sources and to establish standards.
Acinetobacter ; Bacteria ; Cefazolin ; Cefonicid ; Ceftazidime ; Cupriavidus ; Drinking ; Drinking Water ; Hafnia ; Korea ; Mupirocin ; Pseudomonas ; Rahnella ; Serratia ; Staphylococcus ; Water ; Yersinia

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.
Alprostadil ; Education ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Humans ; Male ; Papaverine ; Phentolamine

BACKGROUND/AIMS: Bowel wall thickening on CT has been reported to reflect colorectal carcinoma and colitis. The aim of this study was to evaluate the clinical significance of the large intestinal wall thickening on CT. METHODS: Between January 2006 and August 2010, medical records of 815 patients who underwent endoscopy after CT scans within 1 month were reviewed retrospectively. RESULTS: A total of 233 patients were included. The wall thickening was actually associated with abnormal endoscopic findings in 81.1% of the cases. The accuracy rate on diagnosis between CT and endoscopy was 63.5%. The discrepancy in diagnosis was higher in cases with left colon abnormality and short segment lesion. Abdominal pain was significantly more common in cases suspected malignancy on CT compared with colitis (p=0.047). Most of the malignancy diagnosed on CT involved the left side colon and most of the colitis involved the entire colon (p<0.001). The length of lesion was below 5 cm in 86.5% of the malignancy. Malignancy was more common in patients aged over 50 years with hemoglobin below 12 g/dL. The CT findings significantly suggestive of malignancy were lymph node enlargement and length of lesion below 5 cm (p=0.027 and p<0.001). CONCLUSIONS: The large intestinal wall thickening on CT was limited in the differential diagnosis of malignancy and colitis. Additional endoscopic evaluation is needed in patients with bowel wall thickening associated with lymph node enlargement and short segment lesion on CT in order to exclude malignancy.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colitis/*diagnosis/radiography ; Colonic Neoplasms/*diagnosis/radiography ; Colonoscopy ; Female ; Hemoglobins/analysis ; Humans ; Intestine, Large/*physiopathology ; Lymph Nodes/physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*

BACKGROUND/AIMS: An increasing number of case reports indicate the potential nephrotoxicity of 5-aminosalicylic acid (ASA). The aim of this study was to investigate the effect of long-term use of 5-ASA on renal function in patients with inflammatory bowel disease (IBD). METHODS: The medical records of 318 patients with IBD that were treated with 5-ASA from 2001 to 2007 at Yeungnam University Hospital were reviewed. Changes in creatinine clearance (CCr), as measured by modification of diet with the renal disease study (MDRD) method, and risk factors were analyzed. RESULTS: One-hundred patients were available for analysis. The male to female ratio was 55:45 and the mean age was 35.89+/-14.1 years. Fifty-eight patients were diagnosed with Crohn's disease and the other patients were diagnosed with ulcerative colitis. The mean treatment duration with 5-ASA was 2.6+/-2.5 years and 85 patients were treated with mesalazine and eight patients were treated with sulfasalazine. The mean baseline glomerular filtration rate (GFR) was 112.9+/-25.3 mL/min. The mean CCr declined to 106.3+/-28.3 ml/min/m2 with an annual decline of 1.44 ml/min/year/m2, but there was no statistically significant change in the mean CCr. Changes in the CCr were correlated with the pretreatment CCr. CONCLUSIONS: There was no statistically significant change in serum CCr. Although 5-ASA therapy in IBD patients resulted in no meaningful effect on renal function, the annual decline was within the normal range (0.4-1 mL/min/m2). Serial follow-up of GFR has significance. A large prospective study with a longer time is needed to confirm these findings.
Colitis, Ulcerative ; Creatinine ; Crohn Disease ; Diet ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Inflammatory Bowel Diseases ; Male ; Medical Records ; Mesalamine ; Reference Values ; Risk Factors ; Sulfasalazine

OBJECTIVE: To evaluate the utility of anterior cervical discectomy and fusion (ACDF) with polyetheretherketone (PEEK) cage and autograft through long term(average 36 months) follow-up. METHODS: Thirty selected patients (male:20/female:10) who suffered from cervical radiculopathy, myelopathy or radiculomyelopathy underwent a single level ACDF with PEEK cage and autograft from iliac crest from March 2006 to July 2008 in single institute. We followed patients for an average 36.4+/-8.1 months (ranged from 23 to 49 months). The Japanese Orthopedic Association (JOA) score for evaluation of myelopathy and visual analogue scale (VAS) for radiating pain was used to estimate postoperative clinical outcome. Plain x-ray on true lateral standing flexion, extension and neutral position view and 3D CT scan were used every 6 months after surgery during follow-up period. RESULTS: The mean VAS and JOA scoring improved significantly after the surgery and radiological fusion rate was accomplished by 100% 36 months after the surgery. We had no complication related with the surgery except one case of osteomyelitis. There was one case of Grade I fusion, four cases of grade II, and 25 cases of grade III by radiologic evaluation. CONCLUSION: This long term follow-up study for ACDF with PEEK cage shows that this surgical method is comparable with other anterior cervical fusion methods in terms of clinical outcomes and radiologic fusion rate.
Asian Continental Ancestry Group ; Biocompatible Materials ; Dental Cements ; Diskectomy ; Follow-Up Studies ; Humans ; Ketones ; Orthopedics ; Osteomyelitis ; Polyethylene Glycols ; Radiculopathy ; Spinal Cord Diseases ; Transplants

BACKGROUND/AIMS: Although intravenous proton pump inhibitor (PPI) has been used for the prevention of post endoscopic submucosal dissection (ESD) bleeding, the route of administration has not been confirmed. The aim of the present study was to compare the efficacy of intravenous and oral PPI administration for the prevention of delayed post ESD bleeding. METHODS: Total 166 consecutive patients were randomly assigned to 30 mg lansoprazol twice a day (PO group) and 120 mg pantoprazole intravenous injection (IV group) for 48 hours. Finally, 65 patients in PO group and 87 patients in IV group were analyzed. After ESD, all patients underwent follow up endoscopy after 24 hours and were observed the symptoms of bleeding up to 60 days after ESD. RESULTS: Age, sex and use of anticoagulants were not different between groups. At follow up endoscopy after 24 hours, oozing and exposed vessel was noted in 4.6% of PO group and 8.0% of IV group and there was no significant difference. Delayed bleeding occurred in 4 of 65 patients (6.2%) in the PO group and 8 of 87 patients (9.2%) in the IV group (p>0.999). By multivariate analysis, oozing or exposed vessels at follow up endoscopy were risk factors for delayed bleeding (OR=17.5, p=0.022). CONCLUSIONS: There was no significant difference in the delayed bleeding, length of hospital stay according to the administration route. Bleeding stigmata at follow up endoscopy was risk factor of delayed bleeding. Oral PPI administration can cost-effectively replace IV PPI for prevention of post ESD bleeding.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; *Administration, Oral ; Aged ; Anticoagulants/therapeutic use ; Endoscopic Mucosal Resection/*adverse effects ; Female ; Gastroscopy ; Humans ; *Injections, Intravenous ; Lansoprazole/therapeutic use ; Male ; Middle Aged ; Odds Ratio ; Postoperative Hemorrhage/etiology/*prevention & control ; Prospective Studies ; Proton Pump Inhibitors/*therapeutic use ; Risk Factors ; Stomach Neoplasms/surgery