Objectives: . This study aimed to compare positive airway pressure (PAP) therapy compliance between patients with comorbid insomnia and sleep apnea (COMISA) and those with obstructive sleep apnea (OSA) alone. It also assessed the influence of insomnia clinic visits on PAP compliance. Methods: . Patients diagnosed with OSA and initiated on PAP therapy between January 2012 and December 2021 were included. The COMISA group (n=43) comprised patients with insomnia, while the control group (n=86) consisted of OSA patients without insomnia, matched 1:2 based on age and sex. COMISA patients were further categorized into group A (n=20), with at least two insomnia clinic visits, and group B (n=23) with one or no visits. PAP compliance in each group was evaluated at 3 and 9 months. Results: . No significant differences were observed in PAP compliance between the COMISA patients and OSA patients without insomnia. Within the COMISA group, the impact of insomnia clinic visits on PAP compliance was not significant. No significant difference was observed in daily PAP usage between the two groups at 3 months (265.5±145.9 minutes in group A vs. 236.3±152.3 minutes in group B, P=0.760) or 9 months (213.4±155.3 minutes in group A vs. 166.3±158.3 minutes in group B, P=0.538). The percentages of PAP users and nights with PAP use exceeding 4 hours also showed no significant differences at either time point. Conclusion . This study demonstrated no significant disparity in PAP compliance between the COMISA and OSA groups at either 3 or 9 months. Furthermore, insomnia clinic visits did not significantly impact PAP compliance in COMISA patients during 3- and 9-month intervals.

Grisel’s syndrome is an uncommon disease following the upper neck inflammatory process or ear, nose, and throat procedure. Clinically, it frequently develops in the pediatric population. The most common initial symptom is acute painful torticollis. This report presents a case of Grisel’s syndrome in an 8-year-old girl after tonsillectomy and adenoidectomy. CT was performed for diagnosis, and the patient was diagnosed with Grisel’s syndrome. Cervical halter traction was performed, and finally the patient recovered successfully without any complication.

Background and Objectives: Upon operation of the tongue base for obstructive sleep apnea syndrome (OSAS), the lingual artery and the hypoglossal nerve are put at risk of injury, resulting in fatal complications such as massive bleeding upon damage. We studied the course of lingual artery in its relation with the tongue in OSAS patients and compared it with the age-and- gender-matched normal population.Subjects and Method Korean male patients confirmed with OSAS by polysomnography, including those who had contrast-enhanced computed tomography (ceCT) of the head and neck, were defined as “OSAS group.” Patients who had their ceCT image during the same study period were defined as the “control group.” The control group was paired with the OSAS group by age and sex. By using foramen cecum (FC) as the main reference point, four reference marks were defined. For each reference point, the distance between both lingual arteries and the depth of the lingual artery from the lingual surface of the tongue were evaluated. Results: The depth of the lingual artery from the lingual surface of the tongue in the OSAS group (25.1±8.6 mm) was significantly different from the control (29.5±5.9 mm) at 1 cm anterior to the FC level (p<0.014). The width of both lingual arteries was narrower in the OSAS group (20.9±2.9) than in the control (24.3±6.1) at the FC level (p<0.003). Conclusion The course of lingual artery and its spatial relation with the tongue in Korean male OSAS patients differs from the matched normal population.

Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract. Most NCMH has a benign nature and can be cured by complete resection. Only a few NCMH cases have been reported worldwide due to its rarity. Here, we report three cases of successfully treated NCMH, of which one case was diagnosed during preliminary ultrasound. All three cases were consistent with the benign symptoms of NCMH. Tumor in all of the cases were successfully treated through an endoscopic approach surgery and no evidence of aggressive recurrence was reported.

BACKGROUND/AIMS: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis. METHODS: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver. RESULTS: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000–1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026–4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236–21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis. CONCLUSIONS: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.
Alcohol Drinking ; Body Mass Index ; Colon ; Colonoscopy ; Diverticulum ; Fatty Liver ; Intra-Abdominal Fat ; Mass Screening ; Multivariate Analysis ; Obesity, Abdominal ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Waist-Hip Ratio

OBJECTIVES.: To investigate the apnea-hypopnea index (AHI) according to the sleep stage in more detail after control of posture. METHODS.: Patients who underwent nocturnal polysomnography between December 2007 and July 2018 were retrospectively evaluated. Inclusion criteria were as follows: age >18 years, sleep efficacy >80%, and patients who underwent polysomnography only in the supine position (100% of the time). Patients were classified into different groups according to the methods: the first, rapid eye movement (REM)-dominant group (AHIREM/AHINREM >2), non-rapid eye movement (NREM)-dominant group (AHINREM/AHIREM >2), and non-dominant group; and the second, light sleep group (AHIN1N2>AHISWS) and slow wave sleep (SWS) group (AHISWS>AHIN1N2). RESULTS.: A total of 234 patients (mean age, 47.4±13.9 years) were included in the study. There were 108 patients (46.2%) in the REM-dominant group, 88 (37.6%) in the non-dominant group, and 38 (16.2%) in the NREM-dominant group. The AHI was significantly higher in the NREM-dominant group than in the REM-dominant group (32.9±22.9 events/hr vs. 18.3±9.5 events/hr, respectively). There were improvements in the AHI from stage 1 to SWS in NREM sleep with the highest level in REM sleep. A higher AHISWS than AHIN1N2 was found in 16 of 234 patients (6.8%); however, there were no significant predictors of these unexpected results except AHI. CONCLUSION.: Our results demonstrated the highest AHI during REM sleep stage in total participants after control of posture. However, there were 16.2% of patients showed NREM-dominant pattern (AHINREM/AHIREM >2) and 6.8% of patients showed higher AHISWS than AHIN1N2. Therefore, each group might have a different pathophysiology of obstructive sleep apnea (OSA), and we need to consider this point when we treat the patients with OSA.
Eye Movements ; Humans ; Polysomnography ; Posture ; Retrospective Studies ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM ; Supine Position

BACKGROUND/AIMS: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis.METHODS: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver.RESULTS: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000–1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026–4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236–21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis.CONCLUSIONS: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.
Alcohol Drinking ; Body Mass Index ; Colon ; Colonoscopy ; Diverticulum ; Fatty Liver ; Intra-Abdominal Fat ; Mass Screening ; Multivariate Analysis ; Obesity, Abdominal ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Waist-Hip Ratio

Perforation of the cervical esophagus after thyroidectomy is a rare complication. Esophageal perforation is usually treated conservatively with simple surgical drainage and intravenous antibiotic therapy. If complicated by abscess, it needs aggressive surgery including resection and anastomosis. But the aggressive treatments mentioned have low success and high morbidity. Herein, we report a patient with complicated deep neck infection caused by esophageal perforation following thyroidectomy, which was successfully treated with multiple vacuum-assisted closure and intravenous antibiotic therapy after the failure of simple suture and simple drainage as conservative managements.
Abscess ; Drainage ; Esophageal Perforation* ; Esophagus ; Humans ; Neck ; Negative-Pressure Wound Therapy* ; Sutures ; Thyroidectomy*

Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.
Aged* ; Barium Sulfate* ; Barium* ; Bronchoalveolar Lavage ; Causality ; Comorbidity ; Deglutition Disorders* ; Humans ; Multiple Organ Failure ; Thyrotoxicosis ; Ventilators, Mechanical

IgG4-related sclerosing disease (IgG4-RSD) is characterized by extensive IgG4-positive plasma cell and T-lymphocyte infiltration of various organs. However, the nasal cavity is an extremely rare site of involvement. The authors experienced three cases of igG4-RSD in the nasal cavity. A 54-year-old woman presented with a nasal cavity mass on endoscopic exam and computed tomography (CT) revealed not only a hypoenhancing mass in the right nasal cavity but also a pituitary gland macroadenoma. Endoscopic removal and endoscopic TSA were performed. A 20-year-old man diagnosed with chronic sinusitis, underwent endoscopic sinus surgery. A 26-year-old woman showed thickening of the nasal septum and cribriform plate, and an infiltrating soft tissue lesion in right the alveolar process on CT and an endoscopic biopsy was performed. Pathologic specimens of all cases showed IgG4-positive plasma cell infiltration, consistent with IgG4-RSD. Serum IgG4 levels were checked in two of the cases, and the results were within normal range. All cases were further treated with methylprednisolone and all showed clinical improvement.
Adult ; Alveolar Process ; Biopsy ; Ethmoid Bone ; Female ; Humans ; Immunoglobulin G ; Methylprednisolone ; Middle Aged ; Nasal Cavity* ; Nasal Septum ; Pituitary Gland ; Plasma Cells ; Reference Values ; Sinusitis ; T-Lymphocytes ; Young Adult