Dysphagia is a relatively rare symptom of neurovascular compression of the lower cranial nerve (CN). Many case reviews of neurovascular compression required surgical treatment to improve the neurological symptoms. This report presents a 75-year-old female patient who complained of dysphagia due to neurovascular compression of CNs IX-XI at the left side after the onset period. The symptom was improved by treating with balloon swallowing rehabilitation (BSR). In a video fluoroscopic swallowing study (VFSS), no significant manifestations were observed in the oral phase. On the other hand, profuse post-swallow residue decreased pharyngeal propulsion were observed without aspiration or penetration during the semisolid portion of the swallowing test. To reduce the pharyngeal remnant and improve pharyngeal propulsion, the BSR protocol was performed and the patient recovered quickly.Follow-up VFSS showed improvement in the post-swallow residue from 42.6 to 7.3%. After discharge, the patient could resume a normal diet without complications. Based on this observed result, it is advantageous to consider the option of a prescribed rehabilitation program over surgical treatment.

BACKGROUND: Gerstmann-Straussler-Scheinker disease (GSS) is a type of human transmissible spongiform encephalopathy (TSE) that is determined genetically. CASE REPORT: A 46-year-old woman presented with a slowly progressive ataxic gait and cognitive decline. She was alert but did not cooperate well due to severe dementia and dysarthria. High signal intensities in the cerebral cortices were evident in MRI, especially in diffusion-weighted images (DWI). A prion protein gene (PRNP) analysis revealed a P102L (proline-to-leucine) mutation in codon 102. CONCLUSIONS: This is the first reported case of GSS (confirmed by PRNP analysis) in Korea. Distinctive MRI findings are also presented.
Cerebral Cortex ; Codon ; Dementia ; Dysarthria ; Female ; Gait ; Gerstmann-Straussler-Scheinker Disease ; Humans ; Korea ; Middle Aged ; Prion Diseases

This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
Chronic Disease/*economics/*epidemiology/therapy ; Comorbidity ; Delivery of Health Care/economics/utilization ; Health Care Costs/*statistics & numerical data ; Humans ; Outpatient Clinics, Hospital/*economics/*utilization ; Patient Admission/economics/statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; Unnecessary Procedures/*economics/*utilization ; Utilization Review

PURPOSE: The internet is a vast resource for consumers. The internet is a decentralized, global medium, so quality management of health information is difficult for the lay person. Basic Life Support (BLS) is basic information provided for the lay person in the province of emergency medicine. The writers searched for BLS information on Korean and Japanese Web sites and assessed the quality of that information. METHODS: We used the search engine 'Yahoo! Korea' in Korea and 'Yahoo! Japan' in Japan. The search references were 'Basic Life Support' and 'Cardiopulmonary Resuscitation (CPR)'. The assessment was based on three 'Credibility' and seven 'Content' factors. 'Credibility' factors composed of 'Source', 'Context' and 'Currency'. 'Content' factors composed of six factors of accuracy of six course of BLS and one factor of 'Original Source Stated'. We make our own criteria for each factors. And, If the web site fitted the criteria, we give 1 point, if not, give 0point. So, 'Credibility' factors point is 3 points full mark and 'Content' factors point is 7 points full mark. RESULTS: Eight Korean and fifteen Japanese sites were found as a result of the search. No difference in 'Credibility' factors existed between the two nations' web sites. There was, however, a statistical difference in the 'Content' factors between the two nations' web site. The mean of 'Content' factors points is 3.75 and 5.06 in 7 points full mark, Korean web site and Japanese web site respectively. CONCLUSION: Improvement in the quality of BLS on internet web sites is needed, especially BLS on 'Recovery position', 'Assessment of circulation', and 'Cardiac comp ression'.
Asian Continental Ancestry Group ; Emergency Medicine ; Humans ; Internet* ; Japan* ; Korea* ; Resuscitation ; Search Engine

BACKGROUND AND OBJECTIVES: Computed tomography of the temporal bone (TBCT) provides us many information about the status of temporal bone and middle ear, and is very important for surgical planning. We studied the relations of facial nerve and other structures in temporal bone and factors influencing access to facial recess according to the pneumatizaton of temporal bone. MATERIALS AND METHOD: A total 177 ears were analyzed. With the coronal section on the level just below the second genu of facial nerve, we measured the distances and angle between important surgical landmarks, and compared the data according to the mastoid pneumatization. RESULTS: The distance from sigmoid sinus to posterior wall of external auditory canal, and the distance from sigmoid sinus to line which was drawn at facial nerve parallel to posterior wall of external auditory canal were significantly influenced by temporal bone pneumatization (p<0.05). Temporal bone pnuematization gave no influence on the position of facial nerve, size of facial recess, and posterior fossa. CONCLUSION: Anterior projection of sigmoid sinus into mastoid antrum, which was influenced by pneumatization of mastoid antrum, was the most important factor influencing access to facial recess area.
Colon, Sigmoid ; Ear ; Ear Canal ; Ear, Middle ; Facial Nerve ; Mastoid ; Temporal Bone*

OBJECTIVE: To explore the structure of Internet gaming disorder (IGD) criteria and their distribution according to the different severity level of IGD. The associations of psychiatric comorbidities to each IGD symptom and to the IGD severity were also investigated. METHODS: Consecutively recruited 330 Korean middle school students underwent face-to-face diagnostic interviews to assess their gaming problems by clinicians. The psychiatric comorbidities were also evaluated with a semi-structured instrument. The data was analyzed using principal components analysis and the distribution of criteria among different severity groups was visualized by plotting univariate curves. RESULTS: Two principal components of ‘Compulsivity’ and ‘Tolerance’ were extracted. ‘Decrease in other activities’ and ‘Jeopardizing relationship/career’ may indicate a higher severity of IGD. While ‘Craving’ deserved more recognition in clinical utility, ‘Tolerance’ did not demonstrate much difference in distribution by the IGD severity. Internalizing and externalizing psychiatric disorders differed in distribution by the IGD severity. CONCLUSION: A hierarchic presentation of IGD criteria was revealed. ‘Decrease in other activities’ and ‘Jeopardizing relationship/career’ may represent a higher severity, thus indicating more clinical attention to such symptoms. However, ‘Tolerance’ was not found to be a valid diagnostic criterion.
Comorbidity ; Humans ; Immunoglobulin D ; Internet* ; Pathology*

BACKGROUND: Pulmonary hamartomas are the most common form of pulmonary benign tumors, and they occur in approximately 2~5% of all pulmonary neoplasm. However, only a few reports have been published on the clinical characteristics of pulmonary hamartoma in Korea. MATERIAL AND METHOD: The charts, X-rays and pathological specimens of 37 pulmonary hamartoma patients who were diagnosed by a pathological examination from January of 2000 to May of 2005 at the Catholic Medical Center were retrospectively reviewed. RESULT: The peak incidence of the tumor occurred in the seventh decade of life (32.4%). There were 23 men (62.6%) and 14 women (37.8%), with mean age of 55.6 years. Twenty-six patients (70.3%) were asymptomatic and 11 patients (29.7%) had symptoms. A total of 29 tumors (78.4%) were parenchymal, and 8 (21.6%) were endobronchial. Twenty cases (54.1%) were in the right lung and 17 cases (45.9%) were in the left lung. The right lower lobe was most commonly involved. Thirty-two (86.5%) hamartomas were diagnosed by surgical resection, 4 cases (10.8%) were diagnosed by bronchoscopic biopsy and 1 case (2.7%) was diagnosed by a fine needle aspiration biopsy. Thirty-four hamartomas (91.9%) were managed by surgical resection without complication. No recurrence or malignant changes were seen during the follow up period. CONCLUSION: Pulmonary hamartomas are most common in males during their fifth to seventh decade and they more commonly involve the right lung. No recurrence or malignant changes were seen during the follow up period.
Biopsy ; Biopsy, Fine-Needle ; Female ; Follow-Up Studies ; Hamartoma* ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Male ; Recurrence ; Retrospective Studies

A 68-yr-old man complaining of sudden, postprandial chest pain visited the emergency room. His symptom had been aggravated during the preceding two days. Upper gastrointestinal contrast study with gastrographin showed leakage of dye from the epiphrenic diverticulum in the lower third of the esophagus. The primary repair was urgently carried out. Upper gastrointestinal contrast study 14 days after operation revealed an esophageal leakage which was small and confined. The patient was managed with conservative treatments such as intravenous hyperali-mentation and broad-spectrum antibiotics. Forty-two days after the operation, a gastrographin swallow study showed the absence of leaks. This is the first report-ed case of a perforated epiphrenic esophageal diverticulum repaired by delayed primary repair in Korea.
Aged ; Diverticulum, Esophageal/complications/*diagnosis/*surgery ; Esophageal Perforation/*diagnosis/etiology/*surgery ; Esophagectomy/*methods ; Humans ; Male ; Research Support, Non-U.S. Gov't ; Time Factors ; Treatment Outcome

Microorganisms found in bioaerosols from animal confinement buildings not only foster the risk of spreading diseases among livestock buildings, but also pose health hazards to farm workers and nearby residents. This study identified the various microorganisms present in the air of swine, chicken, and cattle farms with different kinds of ventilation conditions in Korea. Microbial air samples were collected onto Petri dishes with bacterial or fungal growth media using a cascade impactor. Endotoxin levels in total dust were determined by the limulus amebocyte lysate kinetic QCL method. Prevalent Gram-positive bacteria were Staphylococcus (S.) lentus, S. chromogenes, Bacillus (B.) cereus, B. licheniformis, and Enterococcus faecalis, while the dominant fungi and Gram-negative bacteria were Candida albicans and Sphingomonas paucimobilis, respectively. Considering no significant relationship between the indoor dust endotoxin levels and the isolation of Gram-negative bacteria from the indoor air, monitoring the indoor airborne endotoxin level was found to be also critical for risk assessment on health for animals or workers. The present study confirms the importance of microbiological monitoring and control on animal husbandry indoor air to ensure animal and worker welfare.
Agriculture ; Animal Husbandry ; Animals ; Bacillus ; Bacteria* ; Candida albicans ; Cattle ; Chickens* ; Dust ; Enterococcus faecalis ; Farmers ; Fungi* ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Horseshoe Crabs ; Korea ; Livestock ; Methods ; Risk Assessment ; Sphingomonas ; Staphylococcus ; Swine ; Ventilation

Objective: Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic. Methods: We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP] × post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period. Results: A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P < 0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P < 0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P < 0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P < 0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P < 0.001). Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.