Comparison of 'Serial 7's Subtraction' and "Sam-Chun-Ri-Gang-San" Backward for Evaluation of in Primary Medicine

BACKGROUND: There are two variations in the attention subitem of the Mini-Mental State Exam (MMSE): 'serial 7's subtraction and "sam-chun-ri-gang-san" backward. At a scale of one to five, they can be used interchangeably, which inevitably brings a considerable difference in results. Thus, we compared the scores of the 'serial 7's subtraction' and the "sam-chun-ri-gang-san" backward and analyzed the influence of sociodemographic factors on the differences. METHODS: We administered the Korean MMSE including the two types of attention item: serial 7's and "sam-chun-rigang-san" backward to 239 community-dwelling elderly people aged 65 or older in Kyung Hee University Medical Center and four Seoul senior centers and analyzed the difference from June 2012 to July 2012. RESULTS: The score for "sam-chun-ri-gang-san" backward (2.5+/-2.1) was lower than that of the serial 7's (3.4+/-1.7) by a mean point of 0.9+/-1.9. The score of "sam-chun-ri-gang-san" backward was zero in 31.4% of the subjects. However, only 9.6% scored zero on the serial 7's. The ratio of the same scores between two tasks was 36.0%. Education was the primary source of variance on difference score, followed by the number of family. There was no significant effect of age or gender when the score of difference was analyzed by multiple regression. CONCLUSION: In this study, subjects tended to outperform the serial 7's in general. Upon administering "sam-chun-rigang-san" backward instead of serial 7's due to the preference of the patient, we should take into account that the score of "sam-chun-ri-gang-san" backward was 0.9 point (mean value) lower than serial 7's to ensure appropriate interpretation of MMSE score.

Manifestations Like Multiple Sclerosis in a Paitent with Rheumatoid Arthritis and Sjogren's Syndrome / 대한류마티스학회지

Demyelinating syndrome can rarely occur in Sjogren's syndrome or rheumatoid arthritis. We describe a patient of Sjogren's syndrome with multiple sclerosis-like features whose rheumatoid arthritis has been managed for 3 years. The patient presented paraparesis and urinary retention, and improved with high-dose corticosteroid therapy.

Very Late Stent Thrombosis in Coronary Bare-Metal Stent Implantation: A Case Report

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Despite the incidence of stent thrombosis has reduced with improved techniques and drugs, stent thrombosis persists at a rate of 0.5-2% in elective cases, and up to 6% in patients with acute coronary syndromes. It almost always causes acute myocardial infarction or sudden cardiac death. While very late stent thrombosis, occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 880 days after coronary stent implantation.

Comparison of Early and Six Month Outcomes of Direct Stenting vs. Conventional Stenting in Patients with Angina Pectoris

BACKGROUND AND OBJECTIVES: Direct stenting (DS) has been shown to be safe and feasible, with demonstrable reductions in cost, procedural time and radiation exposure, and may also result in less vessel injury. The aim of this study was to compare the immediate and six month clinical and angiographic outcomes of direct stent (DS) with stent implantation implantation following balloon predilatation (conventional stenting, CS). SUBJECTS AND METHODS: Between July 2001 and June 2004, 266 patients (293 lesions) with angina pectoris were included in this study. Patients having lesion characteristics with excessive calcification, left main lesion, chronic total occlusion, severe proximal tortuosity and a bifurcated lesion were excluded. Follow up angiography was performed about six months after the initial procedure. RESULTS: Direct (73 lesions) and conventional stenting (220 lesions) were performed respectively. In the DS group, the minimal luminal diameter was larger (0.36+/-0.18 vs. 0.31+/-0.19 mm, p=0.036) and diameter stenosis lower than in the CS group (89.1+/-5.1 vs. 90.6+/-3.9%, p=0.026). However, no difference was found in the reference vessel diameter between the two groups. From the immediate angiographic results, the CS group showed a longer stent length than the DS group (18.84+/-5.61 vs. 16.16+/-3.67 mm, p=0.000), but the DS group had a higher balloon inflation pressure than the CS group (12.25+/-1.71 vs. 11.35+/-1.72 atm, p=0.000). However, no difference was found in the post-stent minimal luminal diameter, acute gain and angiographic success rates. Follow up angiography was performed in 68.6% (201/293) of lesions. The angiographic restenosis rate was similar between the two groups (DS, 19.6 vs. CS, 19.3%, p=0.966), as were the other angiographic findings. The rates of in-hospital and 6 month follow up major adverse cardiovascular events (MACE) were similar between the two groups. CONCLUSION: Direct stenting showed similar rates of angiographic restenosis as well as inhospital and 6 months MACE (death, myocardial infarction, target lesion revascularization, cerebrovascular accident) compared with conventional stenting.

Clinical Course of The Patient who Had the Gynecologic Operation Using Minilaparotomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical course of the patient who had the gynecologic operation using minolaparotomy. METHODS: We reviewed the chart of the patient who had the gynecologic operation using minilaparotomy in department of obstetrics and gynecology of St. Mary's hospital during Jan. 2000 Sept. 2002. RESULTS: Postopertive diagnosis is myoma (154 cases), adenomyosis (41 cases), ovary cyst (89 cases) and so on. We had performed hysterectomy (225 cases), myomectomy (86 cases), cystectomy or adenexectomy (85 cases) for these patient. There is no significant difference in clinical course between two total hysterecomized groups, one who had the operation history and the other who had not the operation history. CONCLUSION: In gynecological operations, minilaparotomy is the useful methods in any kind of the indication of operation, and show good clinical course.

Comparison of Allergic Skin Prick Test and FAST System in Patients with Allergic Rhinitis

The diagnosis of allergic rhinitis in clinical practice is frequently based on a skin prick test. The measurement of serum levels of specific IgE can be used as an alternative test to the skin prick test. Therefore, we tried to demonstrate the relationship between a skin prick test and Fluoro-Allergo-Sorbent Test (FAST) system in allergic rhinitis patients. In this study, we evaluated the results of skin prick tests and FAST allergens in 90 patients who were confirmed to have allergic rhinitis. The agreement between the skin prick test and FAST was statistically significant for D. pteronyssinus and D. farinae, while less significant for the other allergens. FAST is time and cost-efficient in specific IgE detect, while it shows high-agreement for only a few allergens. As a result, it is considered that there will be some limit in applying the FAST.

Transient Hypocalcemia after Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We reviewed the records of 466 patients who had thyroid surgery. Transient hypocalcemia was found in 50 patients (10.7%). The post-thyroidectomy hypocalcemia is a multifactorial phenomenon. We suppose that the causes of transient hypocalcemia after thyroid surgery were hypoparathyroidism and nonspecific hemodilution. So, we will try to demonstrate the causes. MATERIALS AND METHODS: 30 patients recently undergoing thyroid surgery were prospectively followed. Serum concentrations of total calcium, ionized calcium, albumin, and parathyroid hormone were determined just before and 6, 24, 48, 72, and 96 hours after surgery. RESULTS: In the whole population, there was a statistically significant decrease of parathyroid hormone, total calcium, and albumin when compared with the preoperative levels. But ionized calcium was not changed. The parathyroid hormone, total calcium and ionized calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy. But after hemithyroidectomy, ionized calcium, total calcium and parathyroid hormone levels were decreased to the lower normal limit. CONCLUSION: Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and nonspecific hemodilution.

A Case of Non-recurrent Laryngeal Nerve / 대한이비인후과학회지

A non-recurrent laryngeal nerve is rarely encountered condition, and its anomalous path makes it more vulnerable to injury during thyroid surgery and compression by a thyroid mass. This anomaly appears as a consequence of an aberrant subclavian artery, which arises from an anomaly in the primitive forth aortic arch. So, the surgeon must always be aware of the possibility of a nonrecurrent laryngeal nerve. Pre-operative recognition of this nerve allows surgeons to avoid the nerve injury. In some cases, surgeons are able to predict the presence of this nerve pre-operatively by way of clinical symptoms, chest X-ray or barium swallow. We experienced a case of right nonrecurrent laryngeal nerve during a total thyroidectomy in a 47-year-old female, and report with literature review.

Two Cases of Intradermal Nevus of the External Auditory Canal / 대한이비인후과학회지

The intradermal nevus is composed of nevus cells which are usually referred to as the melanocytic nevi and is a form of benign cutaneous tumor. Although the intradermal nevi are common benign pigmented skin tumors, their occurrence within the external auditory canal is uncommon. The clinical and pathologic features of the intradermal nevus arising within the external auditory canal are presented, with a review of literature.