Survey of Current Status and Cognition of Activities of Daily Living in Dementia Patients: the 2018 “Il-sang-ye-chan” Campaign

BACKGROUND AND PURPOSE: Disability associated with activities of daily living (ADL) is the basis of dementia diagnosis and is an important factor in the care of dementia patients. The status of awareness and burden of ADL disability in dementia patients was investigated six years ago and used as an important reference for “Il-sang-ye-chan” campaign. They were re-investigated in six years and compared with previous results. METHODS: The survey included caregivers of 100 dementia patients listed at the four regional dementia centers. Structured open and closed questions about ADL were asked. Assessments included age, sex, education level, economic status, severity of dementia, caregiving pattern, current statues and cognition of ADL, and caregiver needs. RESULTS: The cognition of ADL was still very low (43%). Increased stress among caregivers was the biggest burden, and they frequently suffered from outing disability (56%), recent memory loss (48%), and loss of bowel/bladder control (40%). The economic burden has been greatly reduced compared with the burden six years ago and the needs of caregivers were still highly about educational guide lines or programs. CONCLUSIONS: Continued interest and further investigation into ADL disability of dementia patients are needed. Korean Dementia Association will further expand the “Il-sang-ye-chan” program: via a multi-domain cognitive intervention program under the Care for ADL in dementia and Relieve symptoms in Dementia Project.

IgG4-Related Hypertrophic Pachymeningitis Mimicking Cerebral Venous Thrombosis

Immunoglobulin G4-related hypertrophic pachymeningitis (IgG4-RHP) is an increasingly recognized manifestation of IgG4-related disease (IgG4-RD), which is a fibroinflammatory condition that can affect virtually any organ. The three hallmark histopathological features of IgG4-RD are lymphoplasmacytic infiltration of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. We report a case of biopsy-confirmed IgG4-RHP that was initially misdiagnosed as cerebral venous thrombosis.

Outbreak of Zika Virus

Zika virus (ZIKV) is a vector-borne flavivirus. It was initially identified in Uganda in 1947, and the first human infection was reported in Nigeria in 1953. Since 2015, ZIKV has been spreading rapidly in Brazil and the Americas. Given its general symptoms, ZIKV is considered to be a mild, febrile illness, although it is associated with severe neurologic complications. On February 1, 2016, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC). We conducted a review of the literature on the epidemiology and transmission, clinical manifestations, and diagnosis of ZIKV. Additionally, we introduce original literature on the current ZIKV outbreak in this review.

Clinical Characteristics of Children with Autism Spectrum Disorder According to the Presence of Motor Stereotypes

OBJECTIVES: Repetitive and stereotyped behaviors are core symptoms in children with autism spectrum disorders (ASD). The purpose of our study was to investigate the frequency of motor stereotypes in ASD children and their clinical features. METHODS: Among 171 ASD children (age range, 3-15), the ASD group with motor stereotypes was defined according to two items in the Korean version of Autism Diagnostic Interview-Revised (K-ADI-R). We compared the clinical features, behavior problems and severity of other domains in the K-ADI-R and executive functions between the ASD group with motor stereotypes and the ASD group without motor stereotypes. RESULTS: Ninety (52.6%) of 171 ASD children had motor stereotypes. The ASD group with motor stereotypes had a lower intelligence quotient score (62.23 vs. 84.94, p<.001) compared to the ASD group without motor stereotypes. The ASD group with motor stereotypes had more impairments in the social interaction domain [adjusted odds ratio (AOR) 1.11, p=.001] and communication domain (AOR 1.15, p=.008). Thought problems and lethargy were more frequent in the ASD group with motor stereotypes than the ASD group without motor stereotypes (AOR 2.059, p=.034 ; adjusted OR 1.045, p=.046). However, no significant differences in executive function were observed between the ASD group with motor stereotypes and the ASD group without motor stereotypes. CONCLUSION: The ASD group with motor stereotypes showed more impairment in social interaction and communication domains, which are core symptoms of autism. Motor stereotypes may indicate greater severity of ASD.

Clinical Characteristics of Pediatric Bipolar Disorder by Subtype in a Korean Inpatient Sample

OBJECTIVES: We compared the clinical presentations of manic and depressive episodes and the treatment response among children and adolescents with bipolar disorder (BD) types I and II and BD not otherwise specified (NOS). METHODS: The sample consisted of 66 patients, aged between 6 and 18 years, who were admitted for BD to a 20-bed child and adolescent psychiatric ward in a university hospital located in Seoul, Korea. RESULTS: Patients with BD type I were more likely to have lower intelligence quotients and exhibit violent behaviors during manic episodes than patients with BD type II or BD NOS and to show better treatment responses during manic episodes than patients with BD NOS. Patients with BD NOS were more likely to have an irritable mood rather than a euphoric mood during the manic phase than patients with BD type I or II and to exhibit violent behaviors during the depressive phase and chronic course than patients with BD type II. CONCLUSION: Pediatric BD patients are heterogeneous with respect to their clinical characteristics. Implications for the usefulness of the current diagnostic subtype categories should be investigated in future studies.

Clinical Characteristics and Precipitating Factors of Adolescent Suicide Attempters Admitted for Psychiatric Inpatient Care in South Korea

OBJECTIVE: We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea. METHODS: The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office. RESULTS: Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge. CONCLUSION: These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.

Long-Term Effect of Intravitreal Ranibizumab Injection on Choroidal Neovascularization in Age-Related Macular Degeneration

PURPOSE: To evaluate long-term efficacy and safety of intravitreal ranibizumab on choroidal neovascularization (CNV) in age-related macular degeneration (AMD) in Korean patients over a 2-year period. METHODS: Twenty-three eyes of 23 patients who underwent intravitreal ranibizumab injection for secondary CNV in AMD were followed up more than 2 years, and their records were retrospectively investigated. The best corrected visual acuity (BCVA), central macular thickness (CRT) were compared at baseline and at 6, 12, 18 and 24 months after injection. RESULTS: The mean BCVA (log MAR) was 0.58 +/- 0.36, 0.54 +/- 0.49, 0.59 +/- 0.49, 0.64 +/- 0.51, and 0.61 +/- 0.51 at baseline, 6, 12, 18 and 24 months, respectively (p = 0.332, p = 1.000, p = 0.670, p = 0.697). The mean CRT was 283.75 +/- 61.41 microm, 239.93 +/- 53.12 microm, 244.89 +/- 47.44 microm, 246.36 +/- 55.78, and 244.70 +/- 54.86 at baseline, 6, 12, 18 and 24 months, respectively (p = 0.009, p = 0.036, p = 0.01, p = 0.015). The mean number of injection was 5.96 +/- 2.93 over a 2-year period. CONCLUSIONS: In Korean patients who underwent intravitreal ranibizumab injection for secondary CNV in AMD, long-term efficacy in diminishing CRT was evident. However, long-term efficacy in increasing visual acuity was not observed.

Regional Brain Perfusion before and after Treatment with Methylphenidate According to the MspI Polymorphism of the Alpha-2A Adrenergic Receptor Gene in Children with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: Dysregulation of the central noradrenergic system may be involved in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). The aim of this study was to examine the differences in pre- and post-treatment cerebral perfusion according to the MspI polymorphisms of the alpha-2A-adrenergic receptor gene (ADRA2A) in children with ADHD. METHODS: Thirty seven drug-naive ADHD children (8.9+1.8 years old, M=32, F=5) were genotyped. Baseline single-photon emission computed tomography (SPECT) and clinical assessments were performed for ADHD children. After treatment with methylphenidate for eight weeks, SPECT and clinical assessment were repeated. RESULTS: No differences in baseline clinical assessments or cerebral perfusion were observed according to the MspI genotype. However, after treatment, ADHD children with the G/G genotype at the MspI polymorphism showed hyperperfusion in the right cerebellar declive (p=.001, uncorrected) and hypoperfusion in the left lentiform nucleus and left cingulate gyrus (p<.001 and p=.001, uncorrected), compared to children without the G/G genotype. CONCLUSION: Although the results of this study should be interpreted cautiously, they suggest a possible role of the MspI polymorphisms of the ADRA2A gene in methylphenidate-induced changes in cerebral perfusion.

Quality of Life Assessment in Patients with Wet Age-Related Macular Degeneration

PURPOSE: This study was performed to assess the relationship between wet age-related macular degeneration (AMD) and quality of life (QOL). METHODS: The National Eye Institute Visual Functioning Questionnaire 25 was administered to 27 wet AMD patients under treatment at Kangbuk Samsung hospital ophthalmology clinic. The relationship between wet AMD and QOL was analyzed according to age, visual acuity status and general health status. RESULTS: Older patients and those with hypertension had significantly lower mean scores for general vision, near vision, distance vision, vision-specific role difficulties and dependency compared to their younger and normotensive counterparts. Patients with cataracts had lower mean scores for general vision and color vision than those without, and patients with unilateral AMD had higher mean scores on the driving subscale of the questionnaire. CONCLUSIONS: Wet AMD has a substantial impact on patient quality of life. A comprehensive approach is required in managing these patients, including treatment of comorbidities such as cataracts and psychological reassurance.

Efficacy of Single-Field Non-Mydriatic Digital Fundus Photography for Screening Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of a single field, non-mydriatic, 45degrees digital photography as a diagnostic tool for diabetic retinopathy. METHODS: A total of 303 consecutive diabetic patients (606 eyes) who underwent digital fundus photography and indirect ophthalmoscopy were included in the present study. The optical discs and macular area of all patients were subjected to single fundus photography using a non-mydriatic 45-degree digital fundus camera. All patients also underwent fundus examinations after pupil dilation via indirect ophthalmoscopy. RESULTS: The sensitivity and specificity for determining diabetic retinopathy were 47.6% and 97.6%, respectively. The false positive rate, false negative rate, positive predictive value, and negative predictive values were 2.3%, 2.1%, 45.5%, and 97.8%, respectively. Among the digital fundus images, 12.9% (78 eyes) were non-gradable. The patients with non-gradable digital fundus images were older (p < 0.001), had a longer duration of diabetes, (p < 0.001) and more often suffered from systemic hypertension (p = 0.003) compared to patients with gradable photographs. CONCLUSIONS: The present study showed that single-field, non-mydriatic, 45 degree digital photography for detecting diabetic retinopathy had relatively low sensitivity and high technical failure rates. The failure rates could be improved with higher resolution non-mydriatic wide-field photography cameras and with additional peripheral images for diabetic retinopathy screening.

Mucinous Adenocarcinoma Involving the Ovary: Comparative Evaluation of the Classification Algorithms using Tumor Size and Laterality

For intraoperative consultation of mucinous adenocarcinoma involving the ovary, it would be useful to have approaching methods in addition to the traditional limited microscopic findings in order to determine the nature of the tumors. Mucinous adenocarcinomas involving the ovaries were evaluated in 91 cases of metastatic mucinous adenocarcinomas and 19 cases of primary mucinous adenocarcinomas using both an original algorithm (unilateral > or =10 cm tumors were considered primary and unilateral or =15 cm were primary, respectively. The diagnostic algorithm using size and laterality, in addition to clinical history, preoperative image findings, and operative findings, is a useful adjunct tool for differentiation of metastatic mucinous adenocarcinomas from primary mucinous adenocarcinomas of the ovary.

Clinical Characteristics of Metastatic Tumors to the Ovaries

Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996- 2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.

Treatment of an omental cyst by laparoscopic surgery / 대한산부인과학회지

Mesenteric cysts are uncommon, and they are histopathologically classified as pseudocyst, mesothelial cyst, lymphangioma and omental cyst. We report a case of a 27-year-old female with a huge cystic mass arising from greater omentum. Patient complained the symptoms of abdominal distention due to massive ascites and intermittent pelvic discomfort. The diagnostic examinations including ultrasonography and computed tomography were performed and identified a huge, intraabdominal cyst. Laparoscopic resection of cyst was done with no clinical and symptomatic evidence of adverse event till 12 months. The diagnostic role of sonography and CT in ascites with unknown etiology is emphasized. Minimal invasive surgery showed comparable result to open exploration.

Adjuvant therapy in high-risk early endometrial carcinoma: a retrospective analysis of 46 cases / 부인종양

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.

Adjuvant therapy in high-risk early endometrial carcinoma: a retrospective analysis of 46 cases / 부인종양

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.

The Increasing Frequency of Cervical Cancer in Korean Women under 35 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The goal of this study was to determine the clinical and epidemiological trends of cervical cancer in young Korean women. Social behavior including sexual habits has changed in Korean women, with sexual activity commencing at a younger age. These changes are likely to influence certain risk factors of cervical cancer, resulting in changing trends in the occurrence of the disease. MATERIALS AND METHODS: The incidence of cervical cancer in women less than 35 years-old between January 1990 and December 2006 was analyzed, and available medical records from January 1996 to December 2006 were reviewed. The clinical, pathological and epidemiologic characteristics and changing trends among these young patients were analyzed. RESULTS: Over the last two decades, the incidence of young (< 35 years) cervical cancer patients increased, more patients had an aggressive form of the disease, and there was a higher rate of women with more advanced education. Human papillomavirus (HPV) infection was detected in 94.0% of the women (63/67) tested. HPV 16 (82.5%) and HPV 18 (12.7%) were the two most common viral infections detected throughout the study period. CONCLUSIONS: The changing trends and risk factors identified suggest a need for more active education of young women about cervical cancer prevention strategies. In addition, young women are strongly recommended to undergo a regular screening test and HPV vaccination.

Association Studies of the CT Repeat Polymorphism in the Cholecystokinin B Receptor Gene with the Diagnosis and the Response of Pharmacotherapy in Korean Patients with Panic Disorder / 대한정신약물학회지

OBJECTIVE: This study aimed to test the possible association between Cholecystokinin B receptor (CCKBR) promoter gene and panic disorder. METHODS: 262 patients with panic disorder and 76 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Allele distribution of CT repeat polymorphism in patients with panic disorder was not different from those of the controls. However, after excluding the patients with panic disorder comorbid with major depressive disorder and other anxiety disorder, we found out the significant association of CCKBR (CT)n repeat with the panic disorder without comorbidities. And we analysed the data as a di-allelic polymorphism with a short (140-162 bp) and a long (164-180 bp) allele. In the di-allelic analysis, there was an excess of the shorter allele in patients with panic disorder. CONCLUSION: The present study suggested that the CCKBR promoter dinucleotide polymorphism may have a potential role for susceptibility to panic disorder in the Korean population and thus calls for consecutive studies in order to pile up the data with larger different ethnic background.

Association Study of A2a Adenosine Receptor Gene Polymorphism in Panic Disorder / 대한정신약물학회지

OBJECTIVE: The adenosine A2a receptor (A2aAR) is thought to be implicated in the pathogenesis of panic disorder because caffeine, a potent antagonist for A2aAR, can precipitate panic attacks, and because disruption of the A2aAR gene increses anxiety-behaviors in mice. Recent studies demonstrated that the A2aAR 1976C>T genetic polymorphism confers susceptibility to panic disorder in Caucasian, though not in Asian. The present study tested the hypothesis that the A2aAR 1976C>T genetic variant confers susceptibility to panic disorder in Korean. METHODS: 258 patients with panic disorder and 117 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Genotype (p=0.389) and allele (p=0.655) distribution of adenosine A2a receptor (A2aAR) polymorphism patients with panic disorder was not significantly different from those of the controls. However, panic disorder with major depressive disorder showed significant association with 1976C allele (p=0.008) and A2aAR 1976C>T genotype (p=0.008). CONCLUSION: This study suggested that the adenosine 1976C>T polymorphism may have a potential role for susceptibility to panic disrder with major depressive disorder in the Korean population. This calls for consecutive studies in order to understand the association of A2aAR polymorphism and various psychiatric disorders.

Association Study of the -36C>T Polymorphism in the Cholecystokinin Promoter Gene with the Diagnosis and the Response of Pharmacotherapy in Korean Patients with Panic Disorder / 대한정신약물학회지

OBJECTIVE: This study aimed to test the possible association between cholecystokinin (CCK) promoter gene and panic disorder. METHODS: 267 patients with panic disorder and 82 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Genotype and allele distribution of CCK promoter -36C>T polymorphism patients with panic disorder was not significantly different from those of the controls. In addition, after excluding panic disorder patients with major depressive disorder, we did not find out the association of CCK-36C>T with the panic disorder without comorbidities. CONCLUSION: This study suggested that the CCK promoter -36C>T polymorphism may have not a potential role for susceptibility to panic disorder in the Korean population. Thus calls for consecutive studies in order to pile up the data with larger different ethnic background.

Obstetric Outcome after Threatened Abortion / 대한산부인과학회잡지

OBJECTIVE: Threatened abortion, one of the most common problems of pregnancy, develops 15-20% of pregnant women and progresses into the abortion in 20-50%. It is related to many obstetrical sequelae. We analyzed the prevalence of complication, disruption of pregnancy and the effect of recent treatments. In ultrasonographic examination, we divided all cases into two groups according to existence of hematoma. We compared the difference of two groups about the prognosis of pregnancy and maternal serum concentration of FP. METHODS: A total 88 cases of threatened abortion and 5741 cases of normal pregnancy were studied from Jan., 1999 through Dec., 2003 at St. Paul Hospital in Seoul, Korea. We analyzed age, gestational age of menstruation and ultrasonogram, parity, results of triple test, existence of hematoma, efficacy of treatment. In all cases, we carried out ultrasonic examination with LogiQ-400 (General Electronics Medical System, Tokyo, Japan). We checked the concentration of FP from triple test. RESULTS: The mean gestational age at diagnosis was 9.2 +/- 3.4 weeks. After threatened abortion, successful cases were 71 and mean gestational age at diagnosis was 9.6 +/- 3.6 weeks. In comparison with 17 unsuccessful cases, whose mean gestational age at diagnosis was 6.6 +/- 1.8 weeks, it was thought to be significant differences (p=0.001). The success rates of pregnancy prolongation between groups of different treatments modalities are nearly similar. Existence of hematoma seems to have little impact on prognoses of pregnancy outcome and there were no meaningful differences of maternal serum FP concentration. CONCLUSION: In this study, we could find no difference between the groups those were treated with various methods. We thought that more systematic analysis about the treatment of threatened abortion would be needed. In the cases that were diagnosed threatened abortion at later gestational age, we could find obvious improvement of the pregnancy outcome. So we conclude that gestational age at the diagnosis is potential parameter of prognosis.