Objectives: . The supine sleep position and the rapid eye movement (REM) stage are widely recognized to exacerbate the severity of obstructive sleep apnea (OSA). Position-dependent OSA is generally characterized by an apnea-hypopnea index (AHI) that is at least twice as high in the supine position compared to other sleep positions. However, this condition can be misdiagnosed if a particular sleep stage—REM or non-REM (NREM)—predominates in a specific position. We explored the impact of the sleep stage on positional dependency in OSA. Methods: . Polysomnographic data were retrospectively analyzed from 111 patients with OSA aged 18 years or older, all of whom had an AHI exceeding five events per hour and slept in both supine and non-supine positions for at least 5% of the total sleep time. The overall ratio of non-supine AHI to supine AHI (NS/S-AHI ratio) was compared between total, REM, and NREM sleep. Additionally, a weighted NS/S-AHI ratio, reflecting the proportion of time spent in each sleep stage, was calculated and compared to the original ratio. Results: . The mean NS/S-AHI ratio was consistent between the entire sleep period and the specific sleep stages. However, the NS/S-AHI ratios for individual patients displayed poor agreement between total sleep and the specific stages. Additionally, the weighted NS/S-AHI ratio displayed poor agreement with the original NS/S-AHI ratio, primarily due to discrepancies in patients with mild to moderate OSA. Conclusion . The weighted NS/S-AHI ratio may help precisely assess positional dependency.

Purpose: We report on three patients who received 0.625% povidone-iodine (PVI) intravitreal injections to treat endophthalmitis that did not respond to conventional antibiotic treatment or were inoperable.Case summary: Case 1 was a 42-year-old female with suspected left-eye endophthalmitis that developed after anterior chamber irrigation to treat silicone oil emulsification. A 0.625% PVI intravitreal injection reduced inflammation of the anterior chamber and the vitreous. Case 2 was an 84-year-old male who was blind in the left eye due to glaucoma. He was diagnosed with endogenous endophthalmitis on the basis of the anterior chamber hypopyon and vitreous inflammation. After 0.625% PVI intravitreal injection, the endophthalmitis resolved without any recurrence. Case 3 was a 49-year-old female with suspected endogenous left-eye endophthalmitis attributable to a liver abscess. Despite intravitreal antibiotic injections, the inflammation worsened. A 0.625% PVI intravitreal injection improved both the anterior chamber and vitreous inflammation. Conclusions Intravitreal 0.625% PVI injection is a useful option when a patient with endophthalmitis is likely to not recover full vision, when surgery cannot be performed, and when there is no response to empirical antibiotics.

Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

We evaluated on the calculation accuracy of treatment planning system (TPS) with phantom having convex and concave surface. The TPS is Eclipse (Varian, USA) using both algorithms AAA and PBC for photon dose calculations. PBC algorithms have three corrections of Batho, modified Batho (M-Batho), and equivalent TAR (E-TAR). The field sizes were 10x10 cm2 and 20x20 cm2, and MLC-shaped fields for these fields. We measured doses at three depths 5, 10 and 15 cm in phantom of SSD=90 cm in the condition of inserted farmer chamber. For given conditions, we have calculated dose with these algorithms and compared them with measured doses. In AAA the calculated doses (dose/MU) were agreed to measured doses within +/-1% in flat and convex surface and were under estimated with -1.9% maximum in concave surface. In PBC the calculated doses were over estimated with +1.7% and +4.1% respectively in flat and convex surface and the differences were from -3.1% to +2.1% in concave surface. In comparison of criteria from AAPM and IAEA reports, and statistical analysis for these results, it is found that the AAA's results are in good agreement with measured values and the M-Batho's results are generally good agreed with measured values among PBC algorithms.
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PURPOSE: At the Emergency Department (ED), echocardiography of patients with chest pain, dyspnea, and syncope is essential to identify the underlying etiology such as acute coronary diseases or other cardiac diseases. Therefore, we studied the accuracy and the clinical value of echocardiography for use by the emergency physician as a tool for the identification and evaluation of cardiac diseases. METHOD: From first, September, 2003 to first, November, 2003, we collected the case histories of 40 patients with suspected cardiac diseases, on whom formal echocardiography had been performed within 2 hours after their initial ED echocardiography. The emergency physicians had a 4-hour didactic training course by cardiologists and 1 month of practical training at a formal echocardiography center, then, they performed the echocardiography using an Acuson ASPENT M ultrasound system with a 3.5-MHz phased-array transducer. Data from the emergency physicians and from the formal echocardiographers were analyzed using the wilcoxson sign test, and the correlation coefficient and p value were calculated. RESULT: There were 28 male patients (70.0%) and 12 female patients (30.0%) and the average age of all patients was 60.9+/-15.5 years. The left ventricular end diastolic diameters (LVEDD) from ED and formal echocardiography were, respectively, 44.6+/-7.9 mm and 48.7+/-6.6 mm (p=0.000), the interventricular septum thicknesses (IVS) were 11.6+/-3.6 mm and 10.9+/-3.0 mm (p=0.064), the left ventricular posterior wall thicknesses (LVPW) were 10.9+/-3.4 mm and 10.1+/-2.00 mm (p=0.178), the ejection fractions (EF) were 59.7+/-15.8% and 60.0+/-16.4%(p=0.312), the left atrium diameters were 36.5+/-6.3 mm and 37.0+/-5.8 mm (p=0.770), the aortic root diameters were 29.2+/-4.0 mm and 33.6+/-3.7 mm (p=0.001), and the inferior vena cava diameters (IVC) were 15.9+/-8.1 mm and 13.3+/-2.5 mm (p=0.444). Except for the LVEDD and the aortic root diameters, there were no significant differences between ED and formal echocardiography, and the presences of regional wall motion abnormalities (RWMA), relaxation abnormalities, right atrium enlargement (RAE), and right ventricle abnormalities were all concordant between the two groups. The correlation coefficients and the p values between ED and formal echocardiography were, respectively, 0.806 and 0.000 for LVEDD, 0.662 and 0.000 for IVS thickness, 0.725 and 0.000 for LVPW thickness, 0.922 and 0.000 for EF, 0.729 and 0.001 for left atrium diameter, 0.331 and 0.037 for aortic root diameter, and 0125 and 0.443 for IVS diameter. CONCLUSION: We suggest that ED echocardiography, like formal echocardiography, with additional focused training can measure and assess the structural and the functional parameters of the heart.
Chest Pain ; Coronary Disease ; Dyspnea ; Echocardiography* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Female ; Heart ; Heart Atria ; Heart Diseases ; Heart Ventricles ; Humans ; Male ; Relaxation ; Syncope ; Transducers ; Ultrasonography ; Vena Cava, Inferior

PURPOSE: To know the effect of elastic stocking on reducing edema and preventing deep vein thrombosis(DVT) after total knee arthroplasty(TKA). MATERIALS AND METHODS: One hundred patients who had received simultaneous bilateral TKA was prospectively evaluated. One extremity was accoutered with elastic stocking while the other, not. The lower extremity circumference was measured at postopertive 2, 5, 7 and 10 days. The patient's satisfaction was asked by means of a questionnaire. We evaluated the DVT case also. RESULTS: The thigh and calf circumferences of elastic stocking side were average 0.70 cm and 0.58 cm shorter than those of non-stocking side, this was found to be statiscally insignificant(p>0.05). Satisfaction rate was 76%. One case of DVT occurred in each of the two groups. CONCLUSION: Elastic stocking application after TKA cannot be expected to reduce lower extremity edema or to prevent DVT. However, the satisfaction rate was high.
Arthroplasty* ; Edema ; Extremities ; Humans ; Knee* ; Lower Extremity ; Prospective Studies ; Surveys and Questionnaires ; Stockings, Compression* ; Thigh ; Veins

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.
Age Distribution ; Carcinoma, Squamous Cell ; Diagnosis ; Drug Therapy ; Glottis ; Hoarseness ; Humans ; Joints ; Korea ; Laryngeal Diseases ; Laryngeal Neoplasms* ; Laryngoscopy ; Larynx ; Male ; Radiation Oncology ; Radiotherapy*

Pneumocystis carinii causes serious pulmonary infection in immunosuppressed patients. This study was undertaken to observe the cytoskeletal proteins of P. carinii by immuno-electron microscopy. P. carinii infection was experimentally induced by immunosuppression of Sprague-Dawley rats for seven weeks, and their lungs were used for the observations of this study. The gold particles localized actin, tropomyosin, and tubulin. The actin was irregularly scattered in the cytoplasm of the trophic forms but was much more concentrated in the inner space of the cell wall of the cystic forms called the inner electron-lucent layer. No significant amount of tropomyosin was observed in either trophic forms or cystic forms. The tubulin was distributed along the peripheral cytoplasm and filopodia of both the trophic and cystic forms rather than in the inner side of the cytoplasm. Particularly, in the cystic forms, the amount of tubulin was increased and located mainly in the inner electron-lucent layer of the cell wall where the actin was concentrated as well. The results of this study showed that the cell wall of P. carinii cystic forms is a structure whose inner side is rich in actin and tubulin. The location of the actin and tubulin in P. carinii suggests that the main role of these proteins is an involvement in the protection of cystic forms from the outside environment by maintaining rigidity of the cystic forms.
Actins/analysis ; Animals ; Cytoskeletal Proteins/*analysis ; Fungal Proteins/*analysis ; Histocytochemistry ; Microscopy, Immunoelectron ; Pneumocystis/*chemistry/cytology ; Rats ; Rats, Wistar ; Support, Non-U.S. Gov't ; Tropomyosin/analysis ; Tubulin/analysis

Hydrogen peroxide has been used for various medical purposes and also recommended in the disinfection process for endoscopes. However, hydrogen peroxide as a cause of chemical colitis or disinfectant colitis has been infrequently reported. The endoscopic findings of hydrogen peroxide induced colitis revealed pseudomembranous-like enteritis such as white plaques, erythema, foamy liquid, patchy, granularity, and ulcerations, resulting from effervescence caused by the release of oxygen from the breakdown of hydrogen peroxide. A 36 year-old single male, who had 30 ml of 3% hydrogen peroxide inserted into his anus the day before due to sexual reasons, was hospitalized as a result of suffering from hematochezia, tenesmus, and lower abdominal pain. Colonoscopy revealed discrete or confluent white plaques adherent to the colonic mucosa, severe erythema on the surrounding mucosa, patchy granularity, and scattered ulcerations up to 28 cm from the anal verge. Pathologic finding revealed inflammatory cells infiltration, variable sized vacuoles, vascular congestion, hemorrhage, fibrin deposition and ulcerations with regenerating epithelium in the lamina propria, consistent with acute mucosal injury caused by hydrogen peroxide. A case of hydrogen peroxide induced colitis is herein reported.
Abdominal Pain ; Adult ; Anal Canal ; Colitis* ; Colon ; Colonoscopy ; Disinfection ; Endoscopes ; Enteritis ; Epithelium ; Erythema ; Estrogens, Conjugated (USP) ; Fibrin ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Male ; Mucous Membrane ; Oxygen ; Ulcer ; Vacuoles

The term enterolith refers to concretions formed within the gastrointestinal tract. Enteroliths are thought to result from stasis and are usually found proximal to an area of stricture or within diverticulum. Meckel's diverticulum occurs in 1% to 3% of the population at autopsy and is the most common congenital anomaly of the gastrointestinal tract. Common complications of Meckel's diverticulum include hemorrhage, infection, inflammation, and intussusception. However, enterolith formation in a Meckel's diverticulum, which referred to as Meckel's enterolith, is rare. A 58-year-old female who experienced constipation and low abdominal pain for 20 years, was admitted due to severe low abdominal pain for 3 days. A 3 2 cm sized, lozenge-shaped radiopaque stone with peripheral dense calcification and radiolucent center, located between two areas of stricture in the distal ileum, was observed in abdominal radiograph, abdominal sonogram, small bowel study, and CT scan. Pathologic findings after surgery reveal an enterolith in Meckel's diverticulum without ectopic gastric mucosa. The case of Meckel's enterolith is herein reported.
Abdominal Pain ; Autopsy ; Constipation ; Constriction, Pathologic ; Diverticulum ; Female ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Inflammation ; Intussusception ; Meckel Diverticulum ; Middle Aged ; Tomography, X-Ray Computed