BACKGROUND: Waist circumference (WC) is a well-known obesity index that predicts cardiovascular disease (CVD). We studied the relationship between baseline WC and development of incident myocardial infarction (MI) and ischemic stroke (IS) using a nationwide population-based cohort, and evaluated if its predictability is better than body mass index (BMI). METHODS: Our study included 21,749,261 Koreans over 20 years of age who underwent the Korean National Health Screening between 2009 and 2012. The occurrence of MI or IS was investigated until the end of 2015 using National Health Insurance Service data. RESULTS: A total of 127,289 and 181,637 subjects were newly diagnosed with MI and IS. The incidence rate and hazard ratio of MI and IS increased linearly as the WC level increased, regardless of adjustment for BMI. When the analyses were performed according to 11 groups of WC, the lowest risk of MI was found in subjects with WC of 70 to 74.9 and 65 to 69.9 cm in male and female, and the lowest risk of IS in subjects with WC of 65 to 69.9 and 60 to 64.9 cm in male and female, respectively. WC showed a better ability to predict CVD than BMI with smaller Akaike information criterion. The optimal WC cutoffs were 84/78 cm for male/female for predicting MI, and 85/78 cm for male/female for predicting IS. CONCLUSION: WC had a significant linear relationship with the risk of MI and IS and the risk began to increase from a WC that was lower than expected.
Adult ; Body Mass Index ; Cardiovascular Diseases ; Cohort Studies ; Female ; Humans ; Incidence ; Male ; Mass Screening ; Myocardial Infarction ; National Health Programs ; Obesity ; Observational Study ; Stroke ; Waist Circumference

Positron emission tomography/computed tomography (PET/CT) is valuable for the diagnosis of malignancies. However, PET/CT is unable to discriminate exactly between inflammation and a neoplasm. We report a case of a 50-year-old man with pulmonary paragonimiasis that was suspicious for lung cancer, as detected by PET/CT. The use of PET/CT revealed multilobulated consolidation on the right lung and patchy consolidation on the left lung, with increased fluorodeoxyglucose (FDG) uptake. In addition, the left paraaortic lymph node (LN) and peripancreatic LN showed enlargement with increased FDG uptake. Lung cancer with multiple lymph node metastases was suspected from the increased standardized uptake values (SUV >4.5) determined by PET/CT. We performed wedge resection via video-assisted thoracic surgery (VATS) and found Paragonimus westermani eggs in the involved tissues.
Diagnosis ; Eggs ; Electrons ; Humans ; Inflammation ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Ovum ; Paragonimiasis* ; Paragonimus westermani ; Positron-Emission Tomography and Computed Tomography* ; Thoracic Surgery, Video-Assisted

Positron emission tomography/computed tomography (PET/CT) is valuable for the diagnosis of malignancies. However, PET/CT is unable to discriminate exactly between inflammation and a neoplasm. We report a case of a 50-year-old man with pulmonary paragonimiasis that was suspicious for lung cancer, as detected by PET/CT. The use of PET/CT revealed multilobulated consolidation on the right lung and patchy consolidation on the left lung, with increased fluorodeoxyglucose (FDG) uptake. In addition, the left paraaortic lymph node (LN) and peripancreatic LN showed enlargement with increased FDG uptake. Lung cancer with multiple lymph node metastases was suspected from the increased standardized uptake values (SUV >4.5) determined by PET/CT. We performed wedge resection via video-assisted thoracic surgery (VATS) and found Paragonimus westermani eggs in the involved tissues.
Diagnosis ; Eggs ; Electrons ; Humans ; Inflammation ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Ovum ; Paragonimiasis* ; Paragonimus westermani ; Positron-Emission Tomography and Computed Tomography* ; Thoracic Surgery, Video-Assisted

OBJECTIVE: A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of Labb in surgical removal of petroclival meningiomas. MATERIALS AND METHODS: The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent and equal on both sides), Type B(confluent and non-dominant on tumor side), Type C(confluent and dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of Labb was analyzed with respect to its draining point and its collaterals to other superficial veins. RESULTS: Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of Labb, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. CONCLUSION: For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of Labb.
Brain Edema ; Colon, Sigmoid ; Constriction ; Drainage ; Humans ; Infarction ; Ligation ; Meningioma* ; Phlebography* ; Postoperative Hemorrhage ; Retrospective Studies ; Veins

The adrenal glands are rarely injured by blunt trauma, because they are well protected by the ribs, paraspinal muscles, and the overlying abdominal contents. Although most of adrenal cysts are clinically silent, the number of incidentally detected adrenal cysts have increased due to advanced and widespread application of various sensitive imaging methods. Recently, we have encountered a case of a 62-year-old man who have developed a left adrenal pseudoeyst one and a half months after the blunt trauma from a pedestrian traffic accident. The pseudocyst was non-functional and measured about 5 * 4 cm in size with the same fluid density of a gall bladder in abdominal computerized tomography(CT). Turbid cystic fluid was aspirated by CT-guided method, and the aspirate was composed of degenerated old blood cells without any malignant cells. Since the cyst was developed following trauma and its microscopic content showed blood cells, impending rupture was anticipated. Hence, a laparoscopic adrenalectomy was performed.
Accidents, Traffic ; Adrenal Glands ; Adrenalectomy ; Blood Cells ; Humans ; Middle Aged ; Paraspinal Muscles ; Ribs ; Rupture ; Urinary Bladder

We describe the case of a patient with symptomatic left cervical ICA stenosis and aneurysm of the left distal anterior cerebral artery. She presented with chronic headache and recurrent attack of right hemiparesis, and underwent staged operations. Using the interhemispheric approach, the intracranial aneurysm was clipped, and there was no postoperative neurologic deterioration. Two months later, a carotid endarterectomy was performed. The patient recovered without complications and angiography revealed relief of carotid stenosis and non-visualization of the aneurysm. The coexistence of symptomatic carotid stenosis and an unruptured intracranial aneurysm poses a therapeutic dilemma; correction of significant stenosis of the internal carotid artery may increase the pressure and turbulence to which the aneurysm is subjected, while the intracranial approach to an aneurysm, when blood flow is decreased by carotid stenosis, may also involve increased risk. In view of the theoretical risk of increased blood flow and turbulence after carotid endarterectomy, aneurysm neck clipping followed by this procedure either in a single stage or separate stages seems to be the another safest management strategy.
Aneurysm* ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Headache Disorders ; Humans ; Intracranial Aneurysm ; Neck ; Paresis

In order to determine the survival rate and prognostic factors of patients with intracranial oligodendroglioma as predictors of survival, a retrospective analysis of a total of 68 cases treated between 1982 and 1992 at our institute was performed. The 5-year and 10-year survival rates were 84.5% and 55.1% respectively while the median survival time was 116+/-5.3 months. The significant factors identified by the univariate analysis included the presence of preoperative seizure, the pre- and postoperative status, the presence of signs of increased intracranial pressure before operation and pathologic grade of the tumors. Factors such as age, types of chief complaints, blood types, the preoperative neurologic deficit, the size of tumor, the enhancement of tumor, cysts in tumor, the extent of removal and the postoperative seizure had no correlations with survival rates. The only significant prognostic factor determined by the multivariate analysis was the pathological grade(p=0.04).
Humans ; Intracranial Pressure ; Multivariate Analysis* ; Neurologic Manifestations ; Oligodendroglioma* ; Retrospective Studies* ; Seizures ; Survival Rate*

The cases of ten patients with schwannomas of the jugular foramen who underwent surgery in our department between 1983 and 1996 are described. Seven were women and three were men(mean age 40 years) and the duration of their symptoms, the most predominant of which were hearing loss and tinnitus, ranged from 1 months to 20 years(median 8.5 months). Computerized tomography was performed in all cases, magnetic resonance imaging in eight, and angiography in three. Depending on their radiological and surgical features, the tumors were classified as follows : Type A, a tumor primarily at the cerebellopontine angle, with minimal enlargement of the jugular foramen(n=5) ; Type B, a tumor primarily at the jugular foramen, with or without intracranial extension(n=4) ; Type C, a primarily extracranial tumor with extension into the jugular foramen(n=0) ; Type D, a dumbbell-shaped tumor with both intra- and extracranial components(n=1). A retromastoid suboccipital craniectomy(RM-SOC) was performed for type A tumors, and the RM-SOC or staged infratemporal fossa approach/RM-SOC was used for type B and D. Total removal was achieved in six cases, and no patient died. Postoperative complications were detected in six cases, with low cranial nerve dysfunction most common(n=5). The follow-up period ranged from 14 to 173(mean 48) months. In one patient, a subtotally-resected tumor recurred ; this was again resected and LINAC radiosurgery was successful. In the remaining nine patients, tumors did not recur. It is suggested that jugular foramen schwannomas could be totally resected by RMSOC/ITFA ; to reduce postoperative complications, cases showing adhesion to critical structures could be managed with sub- or near-total resection.
Angiography ; Cerebellopontine Angle ; Cranial Nerves ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma* ; Postoperative Complications ; Radiosurgery ; Tinnitus ; Treatment Outcome

Neurofibromatosis type 2(NF-2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neurinomas and the frequent association of other central nervous system tumors. We present a retrospective review of 16 patients with NF-2 who were treated at our hospital from 1984 to 1995. In 13 cases, the diagnoses of NF-2 were based on the criteria developed at the Consensus Development Conference of National Institute of Health in the United States, and in another 3 cases, the criterias of NF-2 were not fully satisfied, but the diagnoses of NF-2 were highly suspected. The average age of the patients was 27.6 years, ranging from 13 years to 56 years. The most common symptom was hearing difficulty;intervals between symptom onset and deafness ranged from 8 months to 6 years(mean:2.9 years.) One family of NF-2 was documented, consisting of a sister, a brother and their mother. Nine patients underwent operations on unilateral acoustic neurinomas;these were subtotally removed in eight patient s and totally in one patient. Among these patients, five were deaf on the ipsilateral side at surgery. Among the other four patients with useful hearing before surgery, hearing was preserved to preoperative status in two patients. Four patients with diagnoses of meningioma, received operations to relieve mass effect with subtotal removal in two patients and total removal in the other two. Early diagnosis and treatment are the most important in the management planning of patients with NF-2 for reasons of early manifestation and rapid progression of the disease.
Acoustics ; Central Nervous System Neoplasms ; Deafness ; Diagnosis* ; Early Diagnosis ; Hearing ; Hearing Loss ; Humans ; Meningioma ; Mothers ; Neurofibromatoses* ; Neurofibromatosis 2* ; Retrospective Studies ; Siblings ; United States

For the assessment of clinical management, for the confirmation of clinical findings, and also for the evaluation of new diagnostic techniques to determine the location as well as the extent of area of infarction on evolution in cerebral tissue is essential. Sequential evolution of infarction in 2% 2, 3, 5-triphenyltetrazolium hydrochloride(TTC) staining and its concomitant neurological changes were investigated in the rat following left middle cerebral artery occlusion(MCAO). In addition, the pathological evaluation was performed in the same coronal cut slice of each TTC staining. The results were: 1) In the TTC staining method, the cerebral infarction was not found in the 2 hour group rats, and appeared as white or pink color after 4 hours. 2) The size of infarction was significantly correlated with time of occlusion before sacrifice(p<0.05). The size increment was most obvious between 8 hour and 24 hour groups. 3) The time evolution of cerebral infarction was most prominent in the cerebral cortex, and was minimal in the basal ganglia which are supplied by the 'end artery'. 4) The cerebral infarction appeared first in the coronal cuts at the 4, 6, and 8mm from the frontal pole, which is the main territory of MCA. 5) The cerebral infarction, mainly presented in the 4, 6, and 8mm coronal cuts from the frontal pole, extended from the pyriform cortex to the fronto-parietal cortex. It also appeared at 2, 10mm coronal cuts from the frontal pole in 24 hour group. 6) The neurologic sign was not correlated to the time of MCAO and the size of infarction on evolution. Therefore, the prediction of location and size of area of infarction on evolution was impossible by the neurological status. 7) The histopathological change was detected as early as in 2 hours. However, hematoxylin and eosin(H & E) stained sections showed only subtle changes, such as small irregular areas of cortical spongiosis and neuronal shrinkage up to 8 hours. There was no significant difference between lesion areas of 2 hour and 8 hour groups. The pathological findings of 24 hour group rats was definite and appeared as a central area of coagulation necrosis and rarefaction surrounded by a zone of peripheral spongiosis.
Animals ; Basal Ganglia ; Cerebral Cortex ; Cerebral Infarction* ; Hematoxylin ; Infarction ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Necrosis ; Neurologic Manifestations ; Neurons ; Rats*