Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events; however, many patients with AF are noncompliant with medication regimens, which increases said risk substantially. Suboptimal health literacy presents significant hurdles to compliance with medical treatment. Here we present a case of an elderly Hispanic woman with AF and several comorbidities, including a history of dementia, who presented with consecutive recurrence of acute limb ischemia in the bilateral lower extremities just 3 days apart. Both events were successfully treated with endovascular thrombectomy. This case study not only showcases the efficacy of the latest endovascular technologies, but also draws attention to the importance of strict patient medication adherence in AF and the effects that health literacy can have on said adherence.

Objectives: . Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. Methods: . We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. Results: . In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. Conclusion . ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

Background and Objectives: Sudden sensorineural hearing loss (SSNHL) is characterized by sudden onset of impaired hearing, and systemic steroid is the most widely accepted treatment option for it. The aim of this study is to evaluate the effectiveness of stellate ganglion block (SGB) as a treatment option for SSNHL.Subjects and Method A total of 318 patients diagnosed with SSNHL were treated with systemic steroid and SGB (SGB group, 127 patients) or systemic steroid only (non-SGB group, 191 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel’s criteria. Results: The SGB group did not show any significant effects on hearing improvement compared with the non-SGB group (60% vs. 65%). However, some patients with profound hearing loss of more than 90 dB have recovered above average after the SGB treatment. Also, we used multiple regression analysis to ascertain which factors influenced hearing recovery, and found that the initial pure-tone audiometry thresholds at 2000 Hz and 4000 Hz were statistically associated with hearing recovery. Conclusion In conclusion, SGB did not show a clear therapeutic effect, but suggested the possibility of treatment for improving the inner ear circulation of patients with profound hearing loss.

Background and Objectives: Virtual reality (VR) users have prevalently experienced motion sickness called cybersickness. Recently, it has been suggested that stimulating the mastoid by vibration relieves cybersickness. This study aimed to verify this proposition.Subjects and Method Fifty-four young male adults (aged 18 to 27 years) without any experience of severe motion sickness or cybersickness participated in this study. Participants were divided in half into two groups, the experimental group and control group. The experimental group used VR with mastoid vibration, and the control group experienced VR without mastoid vibration. Participants responded to the simulator sickness questionnaire (SSQ) to quantify cybersickness. Results: The total severity scores of cybersickness in the experimental group ranged from 0 to 183.3 with the mean value of 46.7±49.0. The total severity scores of cybersickness in the control group ranged from 0 to 194.9 with the mean value of 44.9±45.1. There were no significant differences between the two groups. Conclusion There was no improvement of cybersickness in the VR participants when the mastoid was stimulated by vibration. However, cybersickness might be relieved with changes in the VR condition or vibration settings.

Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.

Chronic venous insufficiency (CVI) of the lower extremities manifests itself in various clinical spectrums, ranging from asymptomatic but cosmetic problems to severe symptoms, such as venous ulcer. CVI is a relatively common medical problem but is often overlooked by healthcare providers because of an underappreciation of the magnitude and impact of the problem, as well as incomplete recognition of the various presenting manifestations of primary and secondary venous disorders. The prevalence of CVI in South Korea is expected to increase, given the possible underdiagnoses of CVI, the increase in obesity and an aging population. This article reviews the pathophysiology of CVI of the lower extremities and highlights the role of duplex ultrasound in its diagnosis and radiofrequency ablation, and iliac vein stenting in its management.

Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.
Adult ; Costal Cartilage ; Humans ; Male ; Malocclusion ; Nose ; Rhinoplasty ; Transplants

No abstract available.
Coronary Vessels ; Ultrasonography

Immunoglobulin G4 (IgG4)-related sclerosing disease (RSD) is a chronic inflammatory disorder characterized by elevated serum IgG4 levels as well as an abundant infiltration of IgG4-positive plasmacytes. Involvement of the paranasal sinus is very rare, so it is difficult to make an accurate diagnosis. Hence, various differential diagnoses, which typically include elevated serum IgG4 levels and the infiltration of IgG4-postive cells into tissues, need to be excluded, especially for malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective at inducing IgG4-RSD remission. Recently, a 43-year-old woman presented with a mass originating from the ethmoid sinus, suggesting malignancy. The patient underwent biopsy of the lesion. The pathologic specimen revealed the magnitude of IgG4-positive plasma cell infiltration, which was consistent with IgG4-RSD. In addition, serum IgG4 levels were markedly increased. After glucocorticoid treatment, the serum IgG4 levels decreased and the symptoms improved. We present a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Ethmoid Sinus ; Female ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Paranasal Sinuses ; Plasma Cells