자발성 유양동 뇌허니아 1례

Brain tissue herniation into the mastoid cavity is an uncommon phenomenon ; nevertheless, it has been described since the earliest years of this century. Serious sequelae and central nervous system infection may result from inadequate management, but it has become relatively rare with improved antibiotic treatment and surgical technique. It might be caused by chronic otitis media, previous ear surgery, trauma and neoplasm, or spontaneously. Spontaneous brain herniation is extremely rare. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, meningitis and other neurologic symptoms. Treatment depends on site and size of dura defect. We experienced one case of spontaneous brain herniation into the mastoid cavity, which we treated with surgery

부비동 유두종에서의 FDG 섭취 증가를 보인 예

The false-positive FDG uptakes on head and neck areas are common due to benign lesion, iatrogenic and physiologic changes. The Schneiderian papilloma is uncommon benign tumor arising from the mucosa of the paranasal sinuses and nasal cavity. The findings of paranasal papilloma on conventional modality such as CT and MRI are non-specific and they could be confused with inflammatory polyp or retention cyst. Despite of benign tumor, the papilloma usually shows locally aggressive growth with malignant potential, therefore the FDG can be actively accumulated in this lesion. We describe the case of 18F-FDG PET/CT finding in a 77-year-old woman who demonstrates oncocytic papilloma in maxillary sinus

시신경유두직경에 대한 유두연-황반오목거리의 비를 이용한 시신경유두 크기 평가의 예측력

목적: 시신경유두직경에 대한 유두연-황반오목거리의 비(disc-to-fovea distance to disc-diameter ratio; DF/DD ratio)의 큰 시신경 유두와 작은 시신경유두 구별에 대한 유용성을 알아보았다. 대상과 방법: 정상 및 녹내장 300안을 대상으로 입체 시신경유두 사진을 이용하여 DF/DD ratio를 구하고, 시신경유두 크기에 대한 추정 능력 판정을 위해 Area under the receiver operating characteristics curves (AUCs)와 민감도 및 특이도를 분석했다. 결과: DF/DD ratio를 이용하여 예측한 AUCs는 큰 시신경유두의 경우 0.942, 작은 시신경유두의 경우 0.947이었다. DF/DD ratio 2.0을 기준으로 하였을 때 각각의 진단에 있어 100%의 민감도를 가지나 큰 시신경유두는 70.2%, 작은 시신경유두는 40.9%의 특이도를 보였다. 결론: DF/DD ratio는 큰 시신경유두와 작은 시신경유두의 구별에 유용하며 DF/DD ratio 2.0을 기준으로 설정하면 100%의 민감도를 보였으나 중간 크기의 시신경유두가 작은 시신경유두로 분류될 확률이 높았다.Purpose: To investigate the usefulness of the measurement of disc-to-fovea distance to disc-diameter ratio (DF/DD ratio) in detecting large and small discs. Methods: A total of 300 randomly selected subjects were included in the present study. All patients underwent stereoscopic disc photography and DF/DD ratio, which is the shortest distance between disc margin and fovea divided by mean disc diameter was determined by planimetry. The diagnostic accuracy of DF/DD ratio was evaluated using areas under the receiver operating characteristics curves (AUCs), sensitivity, and specificity. Results: No significant differences in disc-to-fovea distance were observed among small and large disc groups. The DF/DD ratio was significantly lower in subjects with large discs (1.74 ± 0.27) compared with subjects with small discs (2.70 ± 0.15). AUCs of the DF/DD ratio were 0.942 and 0.947 in detecting large and small discs, respectively. In detecting disc size by a fixed DF/DD ratio of 2.0, sensitivity was 100% for both large and small discs, and specificity was 70.1% and 40.9% for the large and small discs, respectively. Conclusions: The DF/DD ratio may be a simple and useful clinical aid in detecting large and small discs. The 2.0 fixed DF/DD ratio, showed 100% sensitivity in detecting both large and small discs, although medium discs may be misdiagnosed as small discs more often than as large discs

소아의 통증성 술기에 있어 Ketamine 비강내 투여와 근육 주사의 진정 정도 비교 연구

Purpose: To compare the efficacy of ketamine between intranasal (IN) administration and intramuscular (IM) injection for pediatric procedural sedation and analgesia (PPSA). Methods: A prospective study was conducted during 3 months. Ketamine was given by IN or IM route before primary repair of facial laceration for procedural sedation. The administration dose was 8 mg/kg for IN and 4 mg/kg for IM. We evaluated resistance scale on administration, sedation scale, satisfaction of physician and parents. Results: One hundred children were enrolled into this study. IN administration was given to 50 children, and IM injection to 50 children each. In the IN group, 75%(36 of 50) showed severe resistance, whereas only 34%(17 of 50) showed severe resistance and 50%(25 of 50) showed mild resistance in IM group. Successful rate of sedation after initial administration was 82%(41 of 50) in IM group and 34% in IN group. Satisfaction of physicians and parents was high in IM injection group. Conclusion: Intranasal administration of Ketamine is less effective and provides lower satisfaction than intramuscular injection for procedural sedation of pediatric patients in the emergency department

진균성 접형동염에 의한 시신경병증 1예

Many information concerning orbital complications of sinus diseases has been published, but reports on optic neuropathy secondary to isolated sphenoid sinus Aspergillosis is extremely rare, which may occur via direct spread of invasive disease or through communicating veins despite intact sinus walls. Optic neuritis is generally defined as an inflammatory neuropathy of the optic nerve usually associated with infectious, inflammatory, compressive, neoplastic or vascular processes. We recently experienced one case of optic neuritis secondary to sphenoid sinus Aspergillosis. A 60-year-old woman with decreased visual acuity and headache was admitted to the Department of Neurology. Suspicious isolated sphenoid lesion on CT and MRI was removed by endoscopic sphenoidotomy. Fungal ball in the right sphenoid sinus was found. On follow up, a recurred fungal ball was noted in the same sphenoid sinus and removed by endoscopic surgery. Adjuvant antifungal chemotherapy was tried but discontinued due to severe side effect. The patient recovered from fungal sinusitis but visual disturbance was unchanged

한국 소아알레르기 질환의 유병률

Asthma and allergic diseases are one of the most common disorders in children. Due to its increased prevalence, as well as the increased morbidity and mortality from these diseases, asthma and allergic diseases have come to be recognized as a major worldwide public health issue. In addition, socioeconomic burden of asthma and allergic diseases also has increased in Korea. The International Study of Asthma and Allergies in Childhood (ISAAC) investigated the worldwide prevalence of asthma and other allergic diseases using simple standardized methods because of the comparison of asthma and allergic diseases between the countries. In Korea, several epidemiologic studies have been conducted to determine the prevalence of asthma in children. Although these studies showed increased prevalence of asthma among Korean children (from 3.4% in 1964 to 10.1% in 1989), these findings were based on data from small numbers of subjects. The first Nationwide Study of Asthma and Allergies in Korean Children, which utilized the Korean version of ISAAC written and video questionnaire, was conducted in 1995 and the second Nationwide Study of Asthma and Allergies in Korean Children was conducted in 2000, directed by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We report here the prevalence of asthma and other allergic diseases in Korean children and adolescents, and show the changes that occurred over this 5 year period. We also describe the risk factors for development of these diseases in Korean children. We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 25,117 children selected from 34 elementary school and 14,946 children selected from 34 middle school across the nation, the response rate was 94.8%. In 2000, 27,831 children selected from 34 elementary school and 15,214 children selected from 34 middle school, and the response rate was 96.4%. From these studies, we can confirm that increase of the prevalences of asthma, allergic rhinitis, and atopic dermatitis in Korea, except the prevalence of food allergy. Especially, the video questionnaire showed increases in the lifetime and 12 month prevalence rates of wheeze at rest, exercise- induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time in middle school children. In addition, the increase of prevalences of symptoms, diagnosis and treatment of atopic dermatitis was noted significantly. Risk factor analysis showed that body mass index (BMI), passive smoking and living with a dog or cat were associated with higher risk of wheeze. Also the occurrence of fever during infancy and the frequent use of antibiotics were associated with the risk of wheeze. In conclusion, during the 5 year period from 1995 to 2000, the prevalences of asthma, allergic rhinitis, and atopic dermatitis has increased in Korean children. BMI, passive smoking, living with a dog or cat, the fever episodes in infancy, and the frequent use of antibiotics in infancy are important risk factors to development of asthma and atopic dermatitis. In the near future, the birth cohort study will be needed to investigate the causes of this increase and the natural course of allergic diseases, then we develop the methods to control asthma and allergic diseases

갈색홍채에서 브리모니딘 0.15%의 야간 항산동 효과

Purpose: To analyze the effect of the daily use of brimonidine tartrate 0.15% on the dark-adapted pupil diameter in dark brown irides. Methods: Twenty-five healthy volunteers administered brimonidine tartrate 0.15% to their right eyes once daily for 3 weeks. Infrared digital photographs of the pupil were taken before administration and 1 hour and 4 hours after administration after dark adaptation (at <0.1 lux ambient illumination for 5 minutes). The diameters of both pupils were measured on the first day, on administration days 7 and 21, and on washout day 7. Results: Four hours after the first administration, pupils showed a decrease of 0.95±0.74 mm, 1.03±0.94 mm, 0.61±0.85 mm on the first day, administration day 7, and administration day 21, respectively (p<0.01), compared with baseline data. The anti-mydriatic effect of brimonidine was sustained for 3 weeks, but the proportions of the eyes showing a reduction in pupil diameter by 0.5 mm or more were 84%, 76%, 68%, and 52% at 4 hours on the first day, administration days 7 and 21, and washout day 7, respectively. Conclusions: The anti-mydriatic effect of the daily use of brimonidine 0.15% on dark brown irides in a scotopic condition is maintained during the instillation period but has a tendency to fade over time. This point should be considered when using this compound as a miotic agent.목적: Brimonidine 0.15% 1일 1회 점안이 갈색홍채에서 암순응반응에 미치는 영향을 알아보고자 한다. 대상과 방법: 갈색홍채의 정상 성인 25명의 우안에 brimonidine 0.15% 안약을 1일 1회 3주간 점안하여 최초값을 기준으로 1주, 3주 후 그리고 중단 1주 후에 각각 점안 전, 점안 1시간, 4시간째 조도 0.1 lux 미만의 암실에서 5분간 암순응한 뒤 적외선 디지털 사진기로 촬영하여 동공크기를 측정하였다. 결과: 점안 후 4시간째 동공크기는 최초값에 비해 점안 시작일, 1주, 3주에 각각 0.95±0.74 mm, 1.03±0.94mm, 0.61±0.85 mm만큼 감소했고(p<0.01), 3주간 항산동효과가 유지됐으나(p<0.05), 점안 후 4시간째 최초값 보다 0.5 mm 이상 감소한 비율은 점안 시작일, 1주, 3주, 중단 1주 후 재점안시 각각 84%, 76%, 68%, 52%로 점차 줄었다. 결론: 갈색홍채에 brimonidine 0.15%를 3주간 점안하는 동안 야간 항산동효과를 보였으나 투약기간의 증가에 따라 효과가 감소하는 경향을 보이므로 축동 목적으로 사용시 이를 고려해야 한다

유리체절제술 후 시행한 백내장 수술에서 유리체절제술이 인공수정체 도수 결정에 미치는 영향

Purpose: To evaluate the effect of vitrectomy in IOL power calculation for cataract surgery in the eyes that previously performed vitrectomy. Methods: This study comprised 41 eyes of 37consecutive patients who underwent cataract surgery after previous vitrectomy. IOL power calculation with the measurement of axial length and corneal power was conducted before vitrectomy and before cataract surgery. Target refractions at each surgery, assuming that the same power of IOL was implanted, were compared to actual manifest refraction after cataract surgery. Results: There was no statistically significant change in both axial length and corneal power after vitrectomy (p>0.05). Before vitrectomy, target refraction was -0.22±0.61D compared to -0.37±0.52D before cataract surgery. The actual refraction after cataract surgery was -0.47±0.94D, and there were no significant differences among the three refractions (p>0.05). Conclusions: In the eyes that underwent vitrectomy, vitrectomy itself does not have an influence on calculating IOL power for cataract surgery.목적: 유리체절제술 후 백내장 수술을 시행 받은 환자에서 유리체절제술이 인공수정체 도수 결정에 미치는 영향을 알아보았다. 대상과 방법: 유리체절제술을 시행 받고 추후에 백내장 수술을 시행 받은 37명(41안)을 대상으로, 유리체절제술 시행 전의 안축장의 길이와 각막곡률값을 측정하여 인공수정체 도수를 계산해두고, 백내장 수술 전 다시 인공수정체 도수를 계산하여 인공수정체를 삽입하였다. 동일한 인공수정체 삽입 시 유리체절제술 시행 전과 후의 측정값으로 계산한 목표 굴절률과 백내장 수술 후의 실제 굴절률을 비교하였다. 결과: 유리체절제술 시행 전 후의 안축장의 길이와 각막곡률값은 유의한 차이가 없었고(p>0.05), 백내장 수술 시 인공 수정체 도수의 목표굴절률은 평균 -0.37±0.52디옵터(Diopters, D), 유리체절제술 시행 전의 측정값으로 계산했을 때의 목표굴절률은 평균 -0.22±0.61D, 술 후 굴절 검사 시 구면렌즈 대응치값은 평균 -0.47±0.94D로 세 굴절률간 의 유의한 차이는 없었다(p>0.05). 결론: 유리체절제술을 시행한 환자에서 백내장 수술 시, 유리체절제술 자체는 인공수정체 도수 결정에는 유의한 영향을 미치지 않는 것으로 생각한다

사람면역결핍바이러스감염 환자에서 2색 및 4색 유세포분석법을 이용한 T 림프구아형 분석

Background: Blood CD4+ T-lymphocyte (T4) count is a major clinical marker for the diagnosis and management of AIDS, and flow cytometry is considered the gold standard for T4 enumeration. Our aim was to compare the 2-color and 4-color flow cytometric methods for T-cell subset analysis in HIV-infected patients. Methods: T-cell subsets such as T3, T4, T8, and CD3+CD4-CD8- double negative T cells (DN T) were analyzed from the whole blood of 40 HIV-infected patients by using both 2-color and 4-color methods on a Cytomics FC500 analyzer. Statistical analyses using simple linear regression, paired t-tests, and Bland-Altman plots were performed. Results: The measured T3 (%), T4 (%), T4 (/μL), T8 (%), T8 (/μL), and DN T (%) differed significantly between the 2 methods (P<0.05), whereas the T4/T8 ratio did not. T3 (%), T4 (%), T4 (/μL), T8 (%), T8 (/μL), and T4/T8 measured by the 2 methods showed good correlation, with correlation coefficients above 0.96, whereas DN T (%) did not. The mean differences in T4 (%) and T8 (%) were 0.39% (limit of agreement (LoA), -1.64~2.43) and 1.26% (LoA, -3.37~5.89), respectively. Conclusions: Although there were statistically significant differences in the T cell subsets measured between the 2 methods, the differences were minor, and the 2 methods showed good correlation. As confirmed in this study, DN T (%) estimated by the 2-color method is lower than the actual value. We suggest that although the 2 methods can be used interchangeably, the 4-color method is recommended for the analysis of some specific subpopulations such as DN T (%).배경: CD4+ 조력림프구의 수치는 HIV 감염 환자의 진단과 치료에 따른 모니터링에 있어서 가장 중요한 지표 중 하나로 유세포분석법은 CD4+ 조력세포수를 측정하는 림프구아형검사의 표준법으로 인식되고 있다. 본 연구에서는 HIV 감염 환자의 T 림프구아형 분석을 위해 4색 분석법과 기존의 2색 분석법을 비교하고자 하였다. 방법: HIV 감염 환자 40명의 전혈을 대상으로 Cytomics FC500 장비로 2색 분석법과 4색 분석법을 각각 이용하여 T 림프구아형 분석을 동시에 실시하였다. 통계적 분석은 회귀분석, paired t-test와 Bland-Altman plot을 사용하였다. 결과: T3 (%), T4 (%), T4 (/L), T8 (%), T8 (/L)와 DN T (%)는 두 방법 간의 차이가 통계적으로 유의하였다. DN T (%)를 제외한 T3 (%), T4 (%), T4 (/L), T8 (%), T8 (/L), T4/T8 비의 상관계수는 0.96 이상으로 두 검사법 간에 밀접한 상관관계를 보였다. T4 (%)와 T8 (%)의 두 방법 간 평균 차이는 각각 0.39% (LoA, -1.64~2.43)와 1.26% (LoA, -3.37~5.89)이었다. 결론: AIDS 환자의 T 림프구아형 분석에 있어서 4색 분석법과 2색 분석법이 통계적으로 유의한 차이를 보였으나, 결과 값의 차이가 작고 두 방법 간 상관관계가 좋으므로 2색 분석 대신 4색 분석도 사용이 가능하겠다. 또한 DN T (%)의 경우 2색 분석법에서 실제보다 더 낮게 측정됨을 확인하였다. 각 검사실의 정책과 여건에 따라 4색 분석 혹은 2색 분석을 선택 가능하지만 DN T를 포함한 일부 특정 아형 분석을 위해서는 4색 분석법이 권장된다

신경섬유종증의 안과적 소견

목적: 신경섬유종증의 안과적 소견과 그 빈도에 대하여 알아보고자 한다. 대상과 방법: 2001년 11월에서 2008년 1월까지 본원 안과를 방문한 환자 중 신경섬유종증의 진단 기준을 충족하는 153명을 대상으로 후향적 연구를 시행하였다. 결과: 남자 77명, 여자 76명이며 평균 나이는 20.44±14.34세이고 신경섬유종증 제1형 112명, 제2형 6명, 분절 제 1형 35명이었다. 신경섬유종증 제1형에서는 리쉬소결절(52.68%), 고도근시(14.29%), 안와 내 얼기형 신경섬유종 (4.46%), 담갈색반점(4.46%), 시신경아교종(3.58%)의 순으로 관찰 되었다. 제2형에서는 망막전막(33.33%), 후 낭하백내장(16.67%), 리쉬소결절(16.67%), 시신경유두부종(16.67%), 시신경아교종(16.67%)의 순으로 관찰되었 고 분절형 제1형에서는 리쉬소결절(25.71%)이 가장 흔하게 관찰되었다. 결론: 신경섬유종증 제1형에서 가장 흔하게 관찰되는 리쉬소결절은 이전 서양에서 발표된 연구보다는 드물게 관찰되었 다. 제2형에서는 망막전막과 후낭하백내장의 빈도가 높았다.Purpose: To report the ophthalmic manifestations of neurofibromatosis in Korea. Methods: Ophthalmologic examinations were performed from November 2001 to January 2008 for 153 consecutive patients who were diagnosed with neurofibromatosis according to the diagnostic criteria for neurofibromatosis. A retrospective analysis was performed according to the medical records of these 153 patients. Results: Seventy seven out of the 153 patients were men, 76 were women and the mean age was 20.44±14.34 years old. One hundred twelve were neurofibromatosis type 1 and six were neurofibromatosis type 2. Remained thirty five were segmental neurofibromatosis type 1. Ophthalmic manifestations of the neurofibromatosis type 1 were Lisch nodule (52.68%), high myopia (14.29%), plexiform neurofibroma in the orbit (4.46%), cafe au lait spots (4.46%) and optic glioma (3.58%). In the neurofibromatosis type 2, epiretinal membrane (33.33%) showed highest incidence and posterior subcapsular opacity (16.67%), Lisch nodule (16.67%), optic disc edema (16.67%), and optic nerve glioma (16.67%) were also noted. Lisch nodule (25.71%) was the most common ophthalmic finding in segmental neurofibromatosis type 1. Conclusions: Lisch nodule, which was the most common manifestation of the neurofibromatosis type 1, was less manifested in our cases compared to the previous reports of western countries. In the neurofibromatosis type 2, epiretinal membrane and posterior subcapsular cataract showed higher incidence than those of other types of neurofibromatosis