Recognition of Musical Nuance in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Emotion perception deficit has long been suggested to be one of the core features of schizophrenia. Although there have been several studies examining responses to facial expressions, few studies addressed music emotion recognition. The aim of this study was to examine the difference in emotion recognition in music between normal subjects and patients with schizophrenia. METHODS: Twenty pieces of music were presented to 43 patients with chronic schizophrenia and 82 healthy controls. The set of music consisted of ten pieces of sad music and ten pieces of cheerful music. The subjects were asked to answer whether each piece of music was sad or cheerful. RESULTS: The correct response rate of music emotion recognition was lower in patients with schizophrenia compared with that in healthy controls (76.67+/-19.03% vs. 93.54+/-8.18%, p<0.001). When subgroup analyses was done by type of music ('sad' or 'cheerful'), patients showed a significantly lower correct response rate in recognizing both sad and cheerful emotion in music than healthy controls (sad emotion : 65.12+/-31.15% vs. 91.95+/-15.27%, cheerful emotion : 88.0+/-16.83% vs. 95.12+/-8.64%). The significant correlations between the clinical symptom severity of schizophrenia and music emotion recognition were not found to be. CONCLUSION: The results suggest that patients with schizophrenia might have difficulties in recognizing musical nuances.

Relationship among Plasma Homocysteine, Folate, Vitamin B12 and Nutrient Intake and Neurocognitive Function in the Elderly

This study examined the relationship among plasma homocysteine, folate, and vitamin B12 levels and neurocognitive function in 118 community-dwelling elderly subjects (mean age, 75.1 +/- 6.7 years). The Mini-Mental State Examination (MMSE-KC) was used to screen and assess neurocognitive function in the participants. Dietary intake data including the use of dietary supplements were obtained using the 24-hour recall method by well-trained interviewers. Plasma folate and vitamin B12 concentrations were analyzed by radioimmunoassay, and homocysteine was assessed by a high performance liquid chromatography-fluorescence method. The proportions of participants with suboptimal levels of plasma folate ( 15 micromol/L) were 16.1%, 5.9%, and 21.2%, respectively. A multiple regression analysis showed that plasma homocysteine was negatively associated with plasma folate and vitamin B12 levels. The MMSE-KC test scores were significantly associated with plasma homocysteine and folate, but not with vitamin B12, after adjusting for age, gender, body mass index, living with spouse, education, current smoking, energy intake, and chronic diseases such as hypertension, diabetes, thyroid disease, dyslipidemia, stroke, and cardiovascular disease. A general linear model adjusted for covariates revealed that MMSE-KC test scores increased from the lowest to the highest quartiles of vitamin B1, vitamin B2, vitamin B6, vitamin B12, and vitamin C intake (p for trend = 0.012, 0.039, 0.014, 0.046, 0.026, respectively). These results indicate that the problem of folate inadequacy and hyperhomocysteinemia are highly prevalent among community-dwelling elderly people and that dietary intake of the B vitamins and vitamin C is positively associated with cognitive function scores.

Development of Guideline for Psychiatric Medical Record and Quality Improvement Following Its Application / 신경정신의학

OBJECTIVES: Medical records are used to store and communicate information about patient treatment. Nowadays, the problem oriented medical record (POMR) is the most frequently used method for medical records. The POMR has the advantage of evaluating the course of treatment; however, it is also criticized for focusing on just symptoms and signs. We propose new guidelines for psychiatric medical records based on a modified POMR. METHODS: We organized a research team of psychiatrists and psychiatric residents and, held weekly research meetings from March 2005 until May 2006. Under close psychiatric chart review, we found several problems with the POMR system, and based on these findings, we discussed various ways of modifying it. RESULTS: We propose the following AMC psychiatric medical record guidelines: 1) Problem lists should be classified into seven categories: psychiatric symptoms, function, risk, environment, special treatment, drug side effects, and medical problems. Additionally, treatment course should be described accordingly. 2) Spontaneous reports by patients should be classified as subjective information, and any contents explored by the clinician, as objective information. Brief scales should be included for the quantitative description of symptoms. 3) Assessment should include symptom severity, treatment response, compliance, and suicidal or violent risk at evaluation point. 4) Specific management strategies such as rationale for dosage adjustment, detailed psychotherapeutic intervention, and psychoeducation should be described in the plan. CONCLUSION: This is one of a few studies proposing guidelines for psychiatric medical records. The application of these will improve the quality of medical records and it is hoped that such guidelines will be used broadly.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.

The Effect of Gradient Ultrafiltration and High Sodium Dialysate on Reducing Complications During Hemodialysis / 대한신장학회잡지

OBJECTIVE: The objective of this study was to determine whether complications and nursing interventions during hemodialysis could be reduced by using gradient ultrafiltration(GUF) and high sodium dialysate(HSD). METHODS: Thirty outpatients who had been on hemodialysis for more than 3 months were enrolled. Patients received Conventional HD(Na+ 137 mEqX4 hrs, constant UF), GUF(UF 62.5%X2 hrs, UF 37.5 %X2 hrs), HSD(Na+ 145 mEqX2 hrs, Na+ 140 mEqX2 hrs) and HSUF(GUF and HSD). Each methods were prescribed for 2 weeks. The clinical features such as thirst, interdialytic weight gain, postdialytic weight loss and MAP(mean arterial pressure) and the frequency of intradialytic complications and nursing interventions were evaluated. RESULTS: The results were as followings. Interdialytic thirst, weight gain, postdialytic weight loss and MAP(pre/post HD) were not significantly different in each method. On the other hand, there was significant difference between 4 methods in serum sodium, osmolality and Hct. There were significantly fewer episodes of hypotention, muscle cramp and headache when using GUF, HSD and HSUF than CHD. The number of nursing interventions was significantly reduced in GUF, HSD and HSUF than CHD. CONCLUSION: Hemodialysis with gradient ultrafiltration and high sodium dialysate leads fewer complications and nursing interventions, more patient's well being.

The Causes and Symptoms of Chest Pain among Young Policemen

BACKGROUND: Chest pain is a problem that primary care physicians commonly face and often unnecessary work-up is done because of its clinical importance of cardiac origin. There are various studies on the causative disorders of chest pain, but studies on young adult males are relatively few. Therefore, we conducted this study on the cause of chest pain among young policemen. METHODS: Diagnosis and classification of chest pain were made among 106 policemen who visited the outpatient department of family medicine at the National Police Hospital from March 1, 2002 to June 30, 2002. RESULTS: The causes of chest pain were musculoskeletal (55%), psychogenic (17%), others (15%), gastrointestinal (7%) and respiratory (6%), but none of them were cardiovascular origin. The nature of chest pain were stabbing (41%), sharp (22%), pressing (18%), squeezing (16%) and substernal discomfort (3%). The duration of chest pain were below 10 minutes (37%), 10 minutes to 1 hour (15%), several hours (20%) and several days (28%). The location of chest pain were left chest (61%), right chest (18%), precordial (7%), epigastric (6%), substernal (4%) and others (4%). The frequencies of chest pain were more than once a day (23%), once a week (26%), once a month (11%), once more than 1 month interval (17%) and first attack (23%). The aggravating factors of chest pain were physical strain (25%), coughing (22%), psychologic stress (16%), smoking (10%), weather change (8%), drinking (7%), resting (5%), and overeating (6%). CONCLUSION: Our study showed that unnecessary tests should be avoided and adequate treatment matched to their causes through exact and detailed history taking should be done, because the causes of chest pain among young policemen are mostly non-cardiovascular origin.

Cold lesions in Tc-MDP bone scans of patients with skeleted metastases / 대한핵의학회잡지

No abstract available.

Evaluation of the effects of amlodipine on ambulatory blood pressure in hypertensive patients

BACKGROUND: A clinical trial was performed to evaluate the antihypertensive efficacy and side effects of amlodipine, a new long-action calcium antagonist, in patients with mild to moderate essential hypertension as measured by 24-h ambulatory blood pressure monitoring. METHODS AND RESULTS: 1) The study patients consisted of 4 men and 6 women, and the mean age was 51 years. Amlodipine monotherapy(5~10mg) was continued for 4 weeks, and blood pressure was measured by 24-h ambulatory blood pressure monitoring. 2) A smooth and sustained lowering of blood pressure was clearly achieved without affecting the circadian rhythm throughout dosing interval. The mean-pressure drop was 21.2/13.7mmHg after 4 weeks of amlodipine monotherapy. 3) The ambulatory pulse rate revealed virtually identical average hourly pulses during the recording period before and after amlodipine treatment. 4) All of the laboratory parameters including blood chemistry, glucose, lipid and electrolytes did not change significantly after 4 weeks of amlodipine monotherapy. 5) Amlodipine therapy resulted in minimal side effects that were well tolerated. CONCLUSIONS: Once-daily amlodipine monotherapy with 5 to 10mg in controlling blood pressure throughout each 24-h cycle is effective and well tolerated in the patients with mild to moderate essential hypertension.

Cathepsin D in Glial Tumors: Comparative Study with PCNA and Cell Cycle Analysis

No abstract available.

The effect of the eradication of helicobater pylori in the duodenal ulcer patients upon the duodenal ulcer recurrence / 대한내과학회지

No abstract available.

The Effect of Lovastatin(Mevacor(R)) in Patients with Hypercholesterolemia

Lovastatin is a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, which catalyzes the conversion of hydroxymethylglutaryl-coenzyme A to mevalonate, anearly and rate-limiting step in the synthesis of cholesterol. We studied the therapeutic effect and safety of lovastatin in 18 patients with nonfamilial primary hypercholesterolemia. Patients received 20mg/day lovastatin therapy as a single evening dose. If the total cholesterol level exceeded 200mg/dl after 2weeks of lovastatin therapy, the dosage of lovastatin was doubled. Mean percent total cholesterol level reductions from baseline were 26.4% and 31.9% after 4, and 8 weeks of lovastatin therapy respectively. Mean percent HDL-cholesterol level increase from baseline were 12% and 13% after 4, and 8 weeks of lovastatin therapy respectively. Adverse effects attributable to lovastatin were mild and temporary and no patient was withdrawn from therapy. We concluded that lovastatin was a well tolerated and effective agent for the treatment of nonfamilial primary hypercholesterolemia. Further studies are needed to establish the long-term safety and effectiveness of this drug.

A Clinical Study on the Hypotensive Effect of Captopril

Antihypertensive effect of angiotensin converting enzyme(ACE) inhibitor Captopril was studied in 34 cases of essential hypertension. A single oral dose of 50mg Captopril was administered daily and blood pressure was followed every 2 weeks. Diuretics were added to patients who responded inadequately after 2 weeks of Captopril single treatment. Alpha-blocker, beta-blocker or calcium channel-blocker was added to patients who responded inadequately after another 2 weeks of Captopril and diuretics combined treatment. In 5 cases, Captopril was raised to 100mg and further antihypertensives were added to unresponded 3 cases. The resuts were as follows; 1) In 15 patients, blood pressure dropped from 170.3+/-10.5mmHg/108.7+/-6.1mmHg to 148.3+/-4.4mmHg/93.3+/-3.7mmHg after 8 weeks of Captopril 50mg single therapy. 2) Hydrochlorothiazide 25mg was added to non-responders, and blood pressure dropped from 180+/-6.7mmHg/111.1+/-6.2mmHg to 155.0+/-15.0mmHg/106.2+/-8.7mmHg in 9 of 19 patients after 8 weeks of combined treatment. 3) Alpha-blocker, Beta-blocker or calcium channel blocker was added to 10 non-responders to Captopril-hyprochlorothiazide combination therapy, and blood pressure dropped from 189.0+/-27mmHg/116+/-10mmHg to 137.8+/-15.5mmHg/88.5+/-10.2mmHg after 8 weeks. 4) Increase of captopril from 50mg to 100mg in 5 random nonresponder cases of Captopril single treatment lowered blood pressure from 168.0+/-13.6mmHg/107.1+/-6.4mmHg to 161+/-15.2mmHg/99+/-8.8mmHg after 2 weeks. 5) Heart rate, and serum creatinine, electrolytes and lipid levels showed no significant interval change. 6) Six patients complained of dry cough and one patient complained of poor appetite but no other clinically significant complications were noted during Captopril treatment.