Use of Various Treatment Modalities for Autism Spectrum Disorder and Mental Retardation

OBJECTIVES: The purpose of this study was to investigate the use of various treatment modalities including pharmacotherapy, education-behavior therapy, and complementary alternative treatment for children with mental retardation (MR) or autism spectrum disorder (ASD) in Korea. METHODS: The sample consisted of 50 parents who have children with MR (N=28) or ASD (N=22), 38 boys, 12 girls ; mean age 14.06 (4.14) years old. A questionnaire was composed of the experienced modality, duration, cost, satisfaction etc. RESULTS: According to the results, 56.0%, 100.0%, and 36.0% of children with MR or ASD have experienced pharmacological treatment, educational-behavioral therapy and complementary alternative medicine (CAM), respectively. Children who experienced education-behavioral therapy and CAM experienced 3.52 kinds of education-behavioral therapy and 2.78 kinds of CAM, respectively. Monthly cost of pharmacological treatment was lowest among three modality categories. Regarding treatment satisfaction by parental report, the lowest score was recorded fir CAM. CONCLUSION: Parents who have a child with MR or ASD are trying many treatment modalities and feeling the burden of their treatment.

Decision Factors in Performance of Intravenous Contrast-enhanced Computed Tomography for Patients with Acute Flank Pain in an Emergency Department

PURPOSE: The aim of this study is to determine decision factors for performance of intravenous (IV) contrast-enhanced computed tomography (CT) for patients with acute flank pain in an emergency department. METHODS: We evaluated patients who presented with acute flank pain and underwent IV contrast-enhanced CT from January 2010 to June 2011. The IV contrast-enhanced CT useful group was defined as patients whose CT findings were equal to the final diagnosis. But urolithiasis was an exception, because enhanced CT is not useful in making the final diagnosis. We conducted a comparison of clinical characteristics and laboratory findings between the IV contrast-enhanced CT useful group and the not useful group. We then performed logistic regression analysis for analysis of independent predictors. RESULTS: A total of 166 patients were enrolled in this study. The IV contrast-enhanced CT useful group included 41 (24.7%) patients. Results of logistic regression analysis demonstrated that right upper quadrant tenderness (p=0.023), right lower quadrant tenderness (p=0.037), and negative hematuria (p=0.007) were independent predictors for the IV contrast-enhanced CT useful group. CONCLUSION: In patients with acute flank pain, performance of IV contrast-enhanced CT is useful for detection of alternative findings in the presence of right upper quadrant tenderness, right lower quadrant tenderness, and negative hematuria.

Decreased Recognition of Facial Affects in Elderly / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate whether elderly and young adults differ in their recognition of facial expressions of emotion. METHODS: A total of 120 (elderly group 53, young group 67) subjects participated in this study. Korean facial expressions of emotion including happiness, sadness, fear, anger, disgust, surprise and neutral were used as stimuli for facial affect recognition test. Computerized facial affect recognition test that consists of facial affect discrimination test and facial affect intensity test was performed. RESULTS: For facial affect discrimination test, there was a significant difference between two groups (F=3.986, p<.01) after controlling the effect of education. Elderly participants showed significantly less correct recognition rate with sadness, anger and disgust (p<.05). For facial affect intensity test, there was no significant difference between the groups in recognition of emotional intensity. Chi-square test or t-test was done according to the clinical variables. Multivariate analysis of covariance was done to test group differences of correct recognition rate and emotional intensity. CONCLUSION: This is the first report of differential decrease of facial affect recognition in elderly using Korean facial expressions. This study suggests that the decrement of facial affect recognition maye be a part of normal aging process.

Capillary Hemangioma of the Left Main Bronchus in an Infant / 대한흉부외과학회지

Capillary hemangioma is the most common vascular tumor in childhood; however, its occurrence in the bronchus is extremely rare. We recently performed a sleeve resection of the left main bronchus on a four-month-old infant with a severe emphysema caused by bronchial capillary hemangioma.

Effects of Inhaled Nitric Oxide on Respiratory System Mechanics in Cats with Methacholine-induced Bronchoconstriction / 대한마취과학회지

BACKGROUND: Nitric oxide (NO) is a selective pulmonary vasodilator, and inhaled NO has bronchodilatory action due to their relaxation effect on conducting airway smooth muscle. The aim of this study was to evaluate the effects of inhaled NO on respiratory system mechanics in cats. METHODS: Nineteen cats were divided into 3 groups according to the doses of NO administered; group C (control, n=7), group 20 (20 ppm of NO, n=7), and group 40 (40 ppm of NO, n=5). After measuring the baseline value, methacholine chloride 25 microgram/kg/min was infused to induce bronchoconstriction. Inhalation of NO was started for each group 15 minutes after methacholine infusion. Pressure, volume, and flow rate were monitored with Bicore CP100 pulmonary monitor and the data were transferred to a personal computer and analyzed by a processing software. Respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated. RESULTS: Methacholine infusion increased both airway and tissue resistances. Fifteen minutes after inhaling NO, airway resistances for NO 20 ppm and 40 ppm decreased to 65.8+/-8.5% and 62.2+/-8.9% of the control value (p<0.05). The values of tissue resistances for NO 20 ppm and 40 ppm decreased to 72.4+/-10.8% and 78.2+/-10.5% of the control value respectively (p<0.05). And thirty minutes after inhaling NO, there were also decreases of airway and tissue viscoelastic resistances in both groups but had no differences compared with fifteen minutes' values. There were no significant differences between the NO 20 ppm and 40 ppm in the values of airway and tissue viscoelastic resistances. CONCLUSION: Inhaled NO of 20 ppm and 40 ppm decreased both airway and tissue viscoelastic resistances and airway resistance was decreased more markedly than tissue resistance. There were no significant differences between 20 ppm and 40 ppm of NO in respiratory system mechanics in cats.

Anesthetic Management with Mivacurium in the Myasthenic Patients: Two cases / 대한마취과학회지

We have used mivacurium in two myasthenic patients, a generalized myasthenia gravis (MG) patient presenting for thymectomy and a Lambert-Eaton myasthenic (LEM) patient for mediastinoscopic lymph node biopsy. Both of them received nitrous oxide/oxygen (1:1)-narcotic-enflurane anesthesia with mivacurium as a muscle relaxant and the neuromuscular blocking effect of mivacurium was monitored continuously through the operation as well as before the induction of anesthesia. The dose of mivacurium for MG patient was 5.5 mg and LEM patient was 12 mg, because MG patient showed more severe clinical symptoms. The response to train-of-four (TOF) ulnar nerve stimulation was recorded using accelography. The onset times to maximal block in MG and LEM patients were 30 and 120 sec, respectively after injection and the recovery times to 25% from maximal block were 117 and 76 min, respectively. Mivacrium would be safe and appropriate for use in myasthenic patients, with relatively small dose under the neuromuscular monitoring.

Anesthesia for Noncardiac Surgery in Heart Transplanted Patients: 2 cases report / 대한마취과학회지

With the introduction of cyclosporine, heart transplantation has become a widely accepted treatment for patients with end-stage heart failure. Number of operation increased steadily during recent 6 years with many postoperative follow up cases. A number of survivors are now presenting for non-cardiac surgery. Cardiac transplanted patients present anesthesiologists with challenging problems related to the infection in immunosuppressed patients, rejection phenomena, denervated heart pathophysiology with altered hemodynamic function of their own and under circumstances of stress and drug therapies. We experienced 2 cases of general anesthesia for noncardiac surgery in heart transplanted patients without important hemodynamic changes. Preoperative evaluation including heart status, rejection, immunosuppressive drug therapy and its complications is mandatory. These patients present few problems during anesthesia if adequate hydration, aseptic technique, selection of proper vasoactive drugs are provided.

The Mechanism of Blood Flow Generation during Closed Chest Cardiac Massage: Transesophageal Echocardiographic Monitoring / 대한마취과학회지

The mechanism of forward blood flow during closed chest cardiac massage remains controversial. Two theories have been suggested: the cardiac pump theory and the thoracic pump theory. Case report is presented to illustrate the use of transesophageal echocardiography during cardiopulmonary resuscitation. The findings included right and left ventricular compression, closure of the mitral valve during compression, opening of the mitral valve during the release phase, and atrioventricular regurgitation during compression, indicating a positive ventricular-to-atrial pressure gradient. These findings suggest that direct cardiac compression was the predominant mechanism of forward blood flow during cardiopulmonary resuscitation in this patient. Transesophageal echocardiography offers a new approach for study of the flows and cardiac morphologic features during chest compressions in humans. An understanding of the actual mechanisms involved is necessary if improved cardiopulmonary resuscitative techniques are to be rationally developed for enhancing the outcome of resuscitation.

The Comparison of the Effect of Enflurane and Propofol on Arterial Oxygenation during One-Lung Ventilation / 대한마취과학회지

BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.

Changes of Arterial Carbon Dioxide Tension Do Not Affect Respiratory System Mechanics in Enflurane Anesthetized Cats / 대한마취과학회지

BACKGROUND: Bronchoconstriction is known to be induced by hypocarbia or hypercarbia. But the above effect has not been studied during general anesthesia. This study was proposed to investigate the effects of hypocarbia and hypercarbia on the respiratory system mechanics in 0.5 MAC enflurane anesthetized cats. METHODS: Six cats, weighing 3.0~3.6 kg were used. Pentobarbital sodium was intraperitonially injected to induce anesthesia and endotracheal intubation was followed. The anesthesia was maintained by 0.5 MAC enflurane, oxygen, and air (FiO2; 0.5). Intermittent mandatory ventilation was applied with Siemens Servo 900C ventilator. The inspiratory flow rate and tidal volume were fixed througout the experiment. Only the respiratory rate was adjusted to achieve normocarbia(PaCO2; 31~38 mmHg), hypercarbia(PaCO2; 38~45 mmHg) and hypocarbia(PaCO2; 24~31 mmHg), which were done not in the order. We used the flow-interruption technique to measure respiratory mechanics. The course of changes in the pressure along with the prefixed flow rate and volume were monitored and recorded with Bicore CP100 pulmonary monitor. The data were transfered to a PC and analyzed by Anadat processing software. Total respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated for normocarbia, hypercarbia and hypocarbia. RESULTS: There are no significant differences of resistances and compliances of respiratory system among hypocarbia, normocarbia and hypercarbia. CONCLUSIONS: The changes in PaCO2 do not influence significantly the resistances and compliances measured by the flow interruption technique used in the study.

Histiocytosis-X with Chronic Weeping Ulcers in the Anogenital Areas

No abstract available.

Multiple Cutaneous Focal Mucinosis with Dermatomal Distribution

We report a case of multiple cutaneous focal mucinosis in a 22 year-old male, who presented with multiple, asymptomatic, nodular lesions on the left upper trunk and left arm which had persisted for about one year. They were 2 to 17 mm in size, firm, yellowish, dome-shaped elevated, slightly movable papules or nodules which were distributed over the area of the left C3-7 and TI-3 sensory dermatomes. The histopathologic findings showed homogeneous mucinous material in the upper dermis. The material was confirmed to be hyaluronic add by, alcian blue stain. Some of the lesions showed improvement with intmlesional injection of triamcinolone acetonide. Such an entity, to the best of our knowledge, has not yet been reported.

Two Cases of Eosinophilic Pustular Folliculitis / 대한피부과학회지

We report 2 cases of eosinophilic pustular folliculitis, one in s 29-year-old woman and the other in a 24-year-old man. Crops of papules and pustules developed on well demarcated, walnut-sized, erythematous plsques on the cheeks and forehead. Eruptions were more pronounced on the periphery of the plaques with central clearing. Blood eosinophilia was evident in case 1. Histologic findings showed a dense inflammatory infiltration and abscesses composed mainly of eosinophils in and around hair follicles, sebaceous glands and around blood vessels. We could see beneficial responses by administration of dapsone in both cases, but its effect was just suppressive and temporary.

Distribution of Keratinophilic Fungi in Soil According to Latitudes in Korea / 대한피부과학회지

With a view to investigating the distribution of keratinophilic fungi in soil according to latitudes in south Korea, soil samples were collected at 81 sites in 17 areas in different latitudes across the country and keratinophilic fungi were isolated by means of Vanbreusegherns technique. The results are summarized as follows : 105 strains of keratinophilic fungi were recovered from 56(69.2%) out of 81 samples. Isolated fungi were composed of 41 strains of Trichophyton ajelloi, 24 stains of Chrysosporium species, 20 strains of Microsporum gypseum, and 20 strains of M. cookei. Frequency of isolation of keratinophilic fungi tended to decrease from higher latitudes down to lower latitudes. In areas of higher latutudes, T. ajelloi and M. cookei were isolated more frequently than in lower latitudes. M. gypseem was most frequent in Cheju City, and Chrysosporium species showed an even distribution, Among three areas under different conditions of moisture and shadedness(i.e., shaded wet, shaded dry, and sunny dry areas), frequency of isolation was highest in shaded dry areas(72.2%). T. ajelloi was the most frequent species in all the three areas, especially in shaded wet areas(53.1%). No M. gypsetcm was found in shaded dry areas. As regards distribution at various sites, roadsides and streamsides exhibited the highest frequency of isolation, and hills the lowest. Except for roadsides, T. ajelloi was the most frequent species at all sites, especially in forests. M. gypseum was frequent at sites beside streams M. cookei at streamsides, fields, and hills and Chrysosporim species in gardens, forests, and streets.

A Case of Vesicular Pemphigoid / 대한피부과학회지

We report herein a case of vesicular pemphigoid in a 39 year-old female, who had 1 month history of multiple, pruritic vesicles with erythematous maeules on the whole body, especielly on the flexural surface. The histological findings showed subepidermal vesicle which contained many neutrophils. Direct immvnofluorescent study of perilesional skin revealed linear deposits of C along the dermoepidermal junction and indirect immunofluorescent study revealed linear deposits of immunoglobulin G and Cy along the dermoepidermal junction. Initially, dapsone was tried without any benefit but skin lesions were controlled by a combination therapy of prednisolone and cyclphosphamide.

Two Cases of Non - venereal Sclerosing Lymphantitis of the Penis / 대한피부과학회지

We report two cases of nonvenereal sclerosing lymphangitis of the penis in a 34-year old man and a 28-year-old man. This disorder is an uncommon condition characterized by asymptomatie, firm, cord-like lesion of unknown etiology. Histopathologic findings reveal hypertrophy and sclerosis of lymphatic vessel walls, and some cases show thrombus formation within dilated vessels. Both cases had typical clinical and histopathologic features. In case I, the lesion resolved spontaneously on several occasions for 10 years. Therefore we argue that some individual may be predisposed to develop the condition, perhaps because of anatomical variation.