BACKGROUND: Under certain conditions, exertional headaches may reflect coronary ischemia. CASE REPORT: A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. CONCLUSIONS: A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test.
Acetylcholine ; Adult ; Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Female ; Headache ; Headache Disorders ; Humans ; Ischemia ; Nitroglycerin ; Spasm ; Thorax

For our survey of the infection frequency and mixed infection of the viruses causing acute respiratory syndromes, we analyzed those viruses from acute respiratory patients in Seoul. Total 1,038 specimens of oropharyngeal swab were tested by the real-time polymerase chain reaction (PCR) kit (Kogenebiotech, Korea) from Jan. to Dec. in 2013. Virus detection rate causing acute respiratory infection was 46% (476/1,038). The most frequently isolated virus was only hRV (21.6%, 103/476), followed by only ADV (8.96%, 93/476), only IFV A (H3N2) (18.1%, 86/476), and only hCoV (7.8%, 37/476) etc. Most of acute respiratory viruses had severe fever. Infection frequency information and mixed infection status on respiratory viruses circulating in Seoul will be helpful for the management of acute respiratory infection and for epidemiological continuous studies.
Coinfection* ; Fever ; Humans ; Real-Time Polymerase Chain Reaction ; Seoul

PURPOSE: The prevalence of atopic dermatitis (AD) has been increased in Korea. We aim to investigate the risk factors for development of AD in infants, especially those factors related to the family history. METHODS: The data from 542 infants in our prospective birth cohort study were analyzed. The data from their parent were collected by questionnaires and skin prick tests. They were regularly followed up at 1 year of age when the presence of AD and allergen sensitization was determined. Various factors such as sex, cesarean section delivery, duration of breast feeding, presence of siblings, vaccination, antibiotic use and pet keeping were also assessed. RESULTS: AD developed in 109 infants (20.4%). In univariate analysis, the presence of either maternal or paternal allergic diseases increased the risk for development of AD in their infants. Multivariate logistic analysis, however, showed that only the presence of maternal allergic diseases correlated with the development of AD (P=0.018). While AD developed in 14.7% in infants of parents with no allergic history, the incidences of AD in infants with a single parent allergy history and in those with 2 parent allergy history were 27.0% and 41.7%, respectively. Their adjusted relative risks (95% confidence intervals) were 1.85 (1.24-2.89) and 2.93 (1.68-4.96), respectively. CONCLUSION: Parental allergic diseases, especially maternal allergic diseases, are possible risk factors for development of AD in Korean infants.
Breast Feeding ; Cesarean Section ; Cohort Studies ; Dermatitis, Atopic ; Female ; Humans ; Hypersensitivity ; Incidence ; Infant ; Korea ; Parents ; Parturition ; Pregnancy ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Risk Factors ; Siblings ; Single Parent ; Skin ; Vaccination

Good’s syndrome is a rare cause of combined B- and T-cell immunodeficiency in adults with a history of thymectomy. The patients with Good’s syndrome are susceptible to encapsulated bacterial infections and opportunistic viral/fungal infections. We report a 63-year-old female patient who was diagnosed with cerebral toxoplasmosis in the middle of monthly immunoglobulin treatment for Good’s syndrome. She was referred owing to progressive dizziness for one week without any neurologic deficits. Although routine laboratory tests and toxoplasma serology exams were within the normal range, brain image studies suggested cerebral toxoplasmosis, which was confirmed by pathology of brain lesions. She was treated with pyrimethamine and sulfadiazine as well as with systemic corticosteroids, and improved without sequelae. Later, her medication was switched to trimethoprim/sulfamethoxazole as a second-line treatment due to sulfadiazine-related neuropathy.

OBJECTIVE: To evaluate respiratory muscle strength in healthy Korean children in order to establish the criteria for normal reference values for future applications. In contrast with the other parameters for testing pulmonary function, normal values for respiratory muscle strength in healthy Korean children have not been assessed to date. METHODS: We conducted a complete survey of 263 students at Sinmyung Elementary School in Yangsan, Gyeongsangnam-do, and measured their height and body weight, performed pulmonary function tests, and evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as measures of respiratory muscle strength. We excluded the subjects with respiratory or cardiovascular diseases that could affect the results. The subjects were children aged 8–12 years, and they consisted of 124 boys and 139 girls. RESULTS: The MIP and MEP values (mean±standard deviation) for the entire subject group were 48.46±18.1 cmH₂O and 47.95±16 cmH₂O, respectively. Boys showed higher mean values for MIP and MEP in every age group. Korean children showed lower mean values for MIP and MEP compared to those in previous studies conducted in other countries (Brazil and USA). CONCLUSION: Our results showed that boys generally have greater respiratory muscle strength than girls. We found a significant difference between the results of our study and those of previous studies from other countries. We speculate that this may be attributed to differences in ethnicity, nutrition, or daily activities.
Body Weight ; Cardiovascular Diseases ; Child* ; Female ; Gyeongsangnam-do ; Humans ; Korea ; Reference Values ; Respiratory Function Tests ; Respiratory Muscles

BACKGROUND/AIMS: To evaluate the technical feasibility of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) with the major portal vein tumor thrombosis (PVTT). METHODS: Ten institutions affiliated with the Korean Stereotactic Radiosurgery Group were provided the contours of four cases: the first case was the first branch PVTT with sufficient normal liver volume (NLV), the second was the first branch PVTT with insufficient NLV, the third was the main trunk PVTT at confluence level, and the fourth was the main trunk PVTT with entire length. The institutions were asked to make SBRT plans according to their current treatment protocols and to complete facility questionnaires. RESULTS: Based on institutional protocols, SBRT was feasible in nine institutions for the first case (32–60 Gy in 3–5 fractions), in eight institutions for the second case (32–50 Gy in 3–5 fractions), in seven institutions for the third case (35–60 Gy in 3–5 fractions), and in four institutions for the fourth case (35–42 Gy in 4–5 fractions). The other institutions recommended hypo- or conventional fractionation due to insufficient NLV or gastrointestinal organ proximity. With analysis of the SBRT dose to the central hepatobiliary tract, the major PVTT could theoretically be associated with a high risk of hepatobiliary toxicity. CONCLUSIONS: Although SBRT is a technically feasible option for HCC with the major PVTT, there was a variability among the participating institutions. Therefore, further studies will be necessary to standardize the practice of SBRT for the major PVTT.
Carcinoma, Hepatocellular ; Clinical Protocols ; Liver ; Portal Vein ; Radiosurgery ; Thrombosis

Since 1995, the Korean Society for Cytopathology has overseen the Continuous Quality Improvement program for cytopathology laboratories. The Committee of Quality Improvement has carried out an annual survey of cytology data for each laboratory and set standards for proficiency tests. Methods: Evaluations were conducted four times per year from 2008 to 2018 and comprised statistics regarding cytology diagnoses of previous years, proficiency tests using cytology slides provided by the committee, assessment of adequacy of gynecology (GYN) cytology slides, and submission of cytology slides for proficiency tests. Results: A total of 206 institutes participated in 2017, and the results were as follows. The number of cytology tests increased from year to year. The ratio of liquid-based cytology in GYN gradually decreased, as most of the GYN cytology had been performed at commercial laboratories. The distribution of GYN diagnoses demonstrated nearly 3.0% as atypical squamous cells. The rate for squamous cell carcinoma was less than 0.02%. The atypical squamous cell/squamous intraepithelial lesion ratio was about 3:1 and showed an upward trend. The major discordant rate of cytology-histology in GYN cytology was less than 1%. The proficiency test maintained a major discordant rate less than 2%. The rate of inappropriate specimens for GYN cytology slides gradually decreased. Conclusions: The Continuous Quality Improvement program should be included in quality assurance programs. Moreover, these data can contribute to development of national cancer examination guidelines and facilitate cancer prevention and treatment.

OBJECTIVE: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases METHODS: 11 hospitals participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. RESULTS: Between Apri1 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. Most of the HAVS cases came from shipbuilding, and 172 of them (92.7 %) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9 %). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6 %) and 4 (12.1 %) cases of occupational asthma, the agents included isocyanate and welding fume, respectively. 64.7 % of the cases of occupational skin diseases were contact dermatitis, and organic solvents and welding fume were the main agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10 (58.8 %) of the cases were diagnosed as squamous cell carcinoma and 5 (29.4 %) as adenoma. CONCLUSION: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.
Adenoma ; Asthma, Occupational ; Busan* ; Carcinoma, Squamous Cell ; Carpal Tunnel Syndrome ; Dermatitis, Contact ; Hand ; Hand-Arm Vibration Syndrome ; Lung Neoplasms ; Occupational Diseases* ; Occupational Medicine ; Prevalence ; Risk Factors ; Skin Diseases ; Solvents ; Specialization ; Ulsan* ; Welding