We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.
Airway Obstruction* ; Apnea ; Continuous Positive Airway Pressure ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Middle Aged ; Nasopharynx ; Polysomnography ; Pseudarthrosis ; Respiration ; Sleep Apnea, Central* ; Sleep Initiation and Maintenance Disorders ; Snoring ; Spinal Fusion ; Spine* ; Transplants

A 67-year old woman was admitted due to left femur neck fracture. Pre-operative laboratory data revealed azotemia, and kidney ultrasonogram and pelvis MRI showed bilateral hydronephrosis and huge uterine myoma. On past history, she had uterine myoma since her thirties, but she refused to undergo operation. We initially planned percutaneous nephrostomy (PCN). After stabilization of renal function, we performed subsequent total hysterectomy after insertion of catheters on both ureters, and PCN catheters were removed after confirming that both ureteral catheters worked well. During follow up period of two months after PCN, renal function was gradually improved, but it was not normalized. Size of removed myoma was about 25x15 cm, and histopathologic findings were consistent with leiomyoma. In conclusion, myoma uteri is one of the rare causes of bilateral hydronephrosis, and it may lead to irreversible damage to kidney if left untreated for a long time.
Aged ; Azotemia ; Catheters ; Female ; Femoral Neck Fractures ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Hysterectomy ; Kidney ; Kidney Failure, Chronic ; Leiomyoma* ; Magnetic Resonance Imaging ; Myoma ; Nephrostomy, Percutaneous ; Pelvis ; Pregnenolone Carbonitrile ; Ultrasonography ; Ureter ; Urinary Catheters ; Uterus

Arterial dissection is an important cause of stroke. We report two cases of isolated posterior inferior cerebellar artery (PICA) dissection diagnosed by high-resolution vessel-wall MRI (HRVW-MRI). One subject complained of abrupt-onset vertigo and headache, and the other subject had headache, vertigo, and Horner syndrome. Conventional MRA showed only focal dilatation of the PICA, but HRVW-MRI revealed intramural hematoma and double-lumen contour in the PICA, suggesting arterial dissection. We suggest that the use of HRVW-MRI should be considered when diagnosing isolated PICA dissection in a PICA infarct with an unknown cause.
Arteries* ; Dilatation ; Headache ; Hematoma ; Horner Syndrome ; Magnetic Resonance Imaging* ; Pica ; Stroke ; Vertigo

OBJECTIVE: The use of Complementary and Alternative Medicine (CAM) is common especially among patients with chronic conditions. The aim of this study was to investigate the percentage and characteristics of patients who make use of CAM and analyse the effect of CAM in RA. METHODS: Two hundreds and twelve patients with RA were interviewed by a trained nurse according to structured questionnaire about sociodemographic features and type, effect and cost of CAM which was used. RESULTS: Among 212 patients with RA, 73 patients had used CAM (34.4%). There was no difference in sociodemographic features between the user and non-user of CAM. The chinese medicine containing herbal medicine and acupuncture (43.8% and 24.7%) was most commonly used. There was no difference in the score of Korean Health Assessment Questionnaire (KHAQ) between the user and non-user of CAM. In the user group, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. The average yearly cost for CAM was 790,000 Won/person and it was about 67.5% of the one for hospital services. CONCLUSION: In patients with RA, the percentage of using CAM was 34.4%. Herbal medicine was most commonly used. CAM did not affect the outcome of the patients with RA. However, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. For the proper management of patients with RA, it is necessary to know further data about the effectiveness and side effects of CAM through experimental and clinical research.
Acupuncture ; Arthritis, Rheumatoid ; Asian Continental Ancestry Group ; Complementary Therapies* ; Herbal Medicine ; Humans ; Surveys and Questionnaires

BACKGROUND: Falls in the elderly can lead to disability, hospitalizations, and premature death. Even if the fall does not cause significant injury, it may lead to fear of falling, loss of self confidence and restriction of ambulation. Thus, we conducted this study to examine the risk factors of falls in the elderly. METHODS: The study population consisted of 70 persons, older than 65 years. Subjocts were subdivided into 3 groups according to their experience of falls, during the past 2 year period. Among them, 30 persons had no previous experience, 20 had one fall, and 20 more than one fall. Age, past history, situations surrounding falls, MMSE K, GDS short form, ADL, IADL, Mini Nutritional assessment (MNA) were reviewed, and the Get up and go test, evaluation of orthostic hypotension and hearing were done. T-test, chi square, ANOVA, logistic regression test using the SAS program was performed. RESULTS: The mean age of the participants was 75.4 years with 62.9% malas. The factors associated with falling were age (P=0.01), scores of MNA (P=0.04), Get up and go test (P=0.004), past history (P=0.01), MMSE K (P=0.02), GDS short form (P=0.001), ADL (P=0.003) and IADL (P=0.002). Those in the group who fell once occured mostly while doing a riskful task, while those who fell more than once happened mostly during positional change (p<0.0001). Independent predictors of falls were get up and go test results and GDS short form scores. CONCLUSION: The independent predictors of falls were Get up and go test results and Geriatric Depression Scale scores.
Activities of Daily Living ; Aged* ; Depression ; Hearing ; Hospitalization ; Humans ; Hypotension ; Logistic Models ; Mortality, Premature ; Nutrition Assessment ; Risk Factors* ; Walking

A 51-year old man presented with generalized edema for 10 days. He was admitted to the hospital for a renal biopsy, and a pancreatic mass was incidentally detected by ultrasonography. The renal biopsy was consistent with membranous glomerulonephritis and the pancreas biopsy revealed chronic granulomatous inflammation with multinucleated giant cells, which was suggestive of tuberculosis of the pancreas. The patient was initially treated with a steroid and anti-tuberculosis drugs, but the proteinuria in the nephrotic range persisted throughout the 3-month follow-up. With the presumed diagnosis of tuberculosis-induced membranous nephropathy, immunosuppressant therapy was stopped and anti-tuberculosis drugs were administered for 31 months. With anti-tuberculous treatment, the proteinuria was reduced from 22 g/day to 0.57 g/day. A follow-up abdominal CT revealed a marked reduction in the size of the pancreatic mass. This finding suggests that the membranous nephropathy in our case was related to the pancreatic tuberculosis rather than it being related to primary nephrotic syndrome.
Biopsy ; Edema ; Follow-Up Studies ; Giant Cells ; Glomerulonephritis, Membranous ; Humans ; Inflammation ; Nephrotic Syndrome ; Pancreas ; Proteinuria ; Tuberculosis

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.
Bronchiectasis ; Japan ; Korea ; Lung ; Lung Diseases ; Mycobacterium avium ; Mycobacterium avium Complex* ; Mycobacterium* ; Needles ; Nontuberculous Mycobacteria ; Solitary Pulmonary Nodule ; United States

Stress-induced cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated. It characterized by transient left ventricular regional wall motion abnormalities (with a peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and/or T wave inversion and minor elevations of the cardiac enzyme levels. The patients in the previous series were usually women over 50 years of age and a triggering event was identified in most cases; these included severe emotional distress or an acute medical illness. Although reports of single episodes of stress-induced cardiomyopathy are not infrequent in the recent medical literature, we report here on a case of stress-induced cardiomyopathy in a young women, and this was related with the post-partum period as a stressful condition.
Cardiomyopathies* ; Chest Pain ; Dyspnea ; Female ; Humans ; Postpartum Period*

BACKGROUND/AIMS: Treatment using multiple daily insulin (MDI) should give diabetic patients many benefits. Nevertheless, few studies have examined the impact of an increased frequency of daily insulin injection on quality of life, anxiety levels, and depression in diabetic patients, and individual's continued compliance with MDI is unclear. This study examined these issues using standardized questionnaires. METHODS: This was a cross-sectional, randomized study. Ninety-nine insulin-treated type 2 diabetic patients (mean age 53.1+/-12 years, mean duration of diabetes 10.3+/-6.5 years) were divided a group (n=50) who injected insulin four times daily (mean age 49.6+/-12.3 years, mean duration of diabetes 6.5+/-6.4 years) and a group (n=49) who injected insulin once or twice daily (mean age 56.4+/-11.6 years, mean duration of diabetes 11.5+/-5.8 years). All patients independently completed the Korean Version of the World Health Organization Quality of Life Scale Abbreviated Version and standardized Hospital Anxiety and Depression Scale for Koreans. RESULTS: No significant differences were evident with respect to age, gender, and duration of diabetes between the two groups (p<0.05). No significant differences were evident in the results of the questionnaires between the two groups, except for the physical health domain (p<0.05). CONCLUSIONS:Multiple daily insulin injections had nearly no influence on quality of life, anxiety levels, or depression in type 2 diabetic patients. Therefore, treatment with MDI should be considered for patients who would benefit from this.
Anxiety ; Compliance ; Depression ; Diabetes Mellitus ; Humans ; Insulin ; Quality of Life ; World Health Organization ; Surveys and Questionnaires

BACKGROUND: Recent studies suggest that serum Cystatin C is both a sensitive marker for renal dysfunction and a predictive marker for cardiovascular diseases. We aimed to evaluate the association between Cystatin C and various biomarkers and to find out its utility in estimating risk for cardiovascular diseases in type 2 diabetic patients. METHODS: From June 2006 to March 2008, anthropometric measurements and biochemical studies including biomarkers for risk factors of cardiovascular diseases were done in 520 type 2 diabetic patients. A 10-year risk for coronary heart diseases and stroke was estimated using Framingham risk score and UKPDS risk engine. RESULTS: The independent variables showing statistically significant associations with Cystatin C were age (beta = 0.009, P < 0.0001), hemoglobin (beta = -0.038, P = 0.0006), serum creatinine (beta = 0.719, beta < 0.0001), uric acid (beta = 0.048, P = 0.0004), log hsCRP (beta = 0.035, P = 0.0021) and homocysteine (beta = 0.005, P = 0.0228). The levels of microalbuminuria, carotid intima-media thickness, fibrinogen and lipoprotein (a) also correlated with Cystatin C, although the significance was lost after multivariate adjustment. Calculated risk for coronary heart diseases increased in proportion to Cystatin C quartiles: 3.3 +/- 0.4, 6.2 +/- 0.6, 7.6 +/- 0.7, 8.4 +/- 0.7% from Framingham risk score (P < 0.0001); 13.1 +/- 0.9, 21.2 +/- 1.6, 26.1 +/- 1.7, 35.4 +/- 2.0% from UKPDS risk engine (P < 0.0001) (means +/- SE). CONCLUSIONS: Cystatin C is significantly correlated with various emerging biomarkers for cardiovascular diseases. It was also in accordance with the calculated risk for cardiovascular diseases. These findings verify Cystatin C as a valuable and useful marker for predicting future cardiovascular diseases in type 2 diabetic patients.
Biomarkers ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Coronary Disease ; Creatinine ; Cystatin C ; Fibrinogen ; Hemoglobins ; Homocysteine ; Humans ; Lipoprotein(a) ; Risk Factors ; Stroke ; Uric Acid