Disseminated Herpes Zoster in an Immunocompetent Elderly Patient

Herpes zoster is a cutaneous infection that is characterized by an acute vesicobullous rash with ipsilateral one or two dermatomal distribution and painful allodynia, while predominantly being found in the elderly. Extensive cutaneous dissemination has been reported in immune-compromised patients, such as those who suffer from HIV infections, cancer, chemotherapy, and corticosteroid therapy patients. However, we report a case of disseminated herpes zoster infection in an immuno-competent elderly individual.

Occurrence of Trochlear Nerve Palsy after Epiduroscopic Laser Discectomy and Neural Decompression

Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).

Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study / 예방의학회지

OBJECTIVES: To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults. METHODS: The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index. RESULTS: Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers. CONCLUSIONS: The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

A comparative study on the usefulness of the Glidescope or Macintosh laryngoscope when intubating normal airways / 대한마취과학회지

BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways.

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2010 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The Korean National Cancer Screening Survey (KNCSS) is a continuous nationwide survey implemented by the National Cancer Center in Korea since 2004. The purpose of the present study was to report trends in cancer screening rates for the five major cancers (stomach, liver, colorectal, breast, and cervix uteri) in Korean men and women. MATERIALS AND METHODS: The study used KNCSS data collected between 2004 and 2010. The survey was conducted on Korean men aged 40-74 years and Korean women aged 30-74 years with no history of cancer diagnosis. The annual percentage change and corresponding 95% confidence intervals were used to examine changes in annual screening rates. RESULTS: Screening rates with recommendation increased by 4.4% annually for stomach cancer, 1.5% for liver cancer, 2.8% per year for colorectal cancer, 4.5% for breast cancer, and 1.2% for cervix uteri cancer. The increasing trend in cancer screening rates, with the exception of liver cancer, was significant. CONCLUSION: Cancer screening rates have increased consistently from 2004 to 2010 among Korean men and women. Stomach and breast cancer screening rates in particular have increased markedly.

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2010 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The Korean National Cancer Screening Survey (KNCSS) is a continuous nationwide survey implemented by the National Cancer Center in Korea since 2004. The purpose of the present study was to report trends in cancer screening rates for the five major cancers (stomach, liver, colorectal, breast, and cervix uteri) in Korean men and women. MATERIALS AND METHODS: The study used KNCSS data collected between 2004 and 2010. The survey was conducted on Korean men aged 40-74 years and Korean women aged 30-74 years with no history of cancer diagnosis. The annual percentage change and corresponding 95% confidence intervals were used to examine changes in annual screening rates. RESULTS: Screening rates with recommendation increased by 4.4% annually for stomach cancer, 1.5% for liver cancer, 2.8% per year for colorectal cancer, 4.5% for breast cancer, and 1.2% for cervix uteri cancer. The increasing trend in cancer screening rates, with the exception of liver cancer, was significant. CONCLUSION: Cancer screening rates have increased consistently from 2004 to 2010 among Korean men and women. Stomach and breast cancer screening rates in particular have increased markedly.

Non-Type I Cystinuria Associated with Mental retardation and Ataxia in a Korean Boy with a New Missence Mutation(G173R) in the SLC7A9 Gene

Cystinuria is an inherited renal and intestinal disease characterized by defective amino acids reabsorption and cystine urolithiasis. It is unusually associated with neurologic symptoms. Mutations in two genes, SLC3A1 and SLC7A9, have been identified in cystinuric patients. This report presents a 13-yr-old boy with cystinuria who manifested difficulty in walking, ataxia, and mental retardation. Somatosensory evoked potential of posterior tibial nerve stimulation showed the central conduction dysfunction through the posterior column of spinal cord. He was diagnosed non-type I cystinuria by urinary amino acid analysis and oral cystine loading test. We screened him and his family for gene mutation by direct sequencing of SLC3A1 and SLC7A9 genes. In this patient, we identified new missence mutation G173R in SLC7A9 gene.

The Effects of Paracetamol, Ketorolac, and Paracetamol Plus Morphine on Pain Control after Thyroidectomy

BACKGROUND: The aim of this study was to compare the efficacy of ketorolac, paracetamol, and paracetamol plus morphine on pain relief after thyroidectomy. METHODS: Eighty patients were randomly allocated to one of the 4 groups: normal saline (group C), ketorolac 30 mg (group K), paracetamol 1 g (group P), and paracetamol 700 mg plus morphine 3 mg (group PM). Each regimen was administered intravenously (IV) 30 min. before the end of surgery. If pain was not relieved, patients received an IV bolus of pethidine hydrochloride 25 mg. Pain intensity using a visual analogue scale (VAS) was recorded at 0.5, 1, 2, 4, and 6 hr after the end of surgery. RESULTS: VAS at 0.5 and 1 hr after the end of surgery were significantly lower in group K, group P, and group PM than in group C (P 0.05). CONCLUSIONS: Paracetamol 1 g IV possesses a similar analgesic efficacy to ketorolac 30 mg IV after thyroidectomy. Paracetamol may represent an alternative to ketorolac for pain prevention after mildly to moderately painful surgery in situations where the use of NSAIDs is unsuitable.

Awake Glidescope(R) intubation in a patient with a huge and fixed supraglottic mass: A case report / 대한마취과학회지

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.

Cigarette Smoking and Mortality in the Korean Multi-center Cancer Cohort (KMCC) Study / 예방의학회지

OBJECTIVES: The aim of this study was to evaluate the association between cigarette smoking and total mortality, cancer mortality and other disease mortalities in Korean adults. METHODS: A total of 14 161 subjects of the Korean Multi-center Cancer Cohort who were over 40 years of age and who were cancer-free at baseline enrollment reported their lifestyle factors, including the smoking status. The median follow-up time was 6.6 years. During the follow-up period from 1993 to 2005, we identified 1159 cases of mortality, including 260 cancer mortality cases with a total of 91 987 person-years, by the national death certificate. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cigarette smoking for total mortality, cancer mortality and disease-specific mortality, as adjusted for age, gender, the geographic area and year of enrollment, the alcohol consumption status, the education level and the body mass index (BMI). RESULTS: Cigarette smoking was significantly associated with an increased risk of total mortality, all-cancer mortality and lung cancer mortality (p-trend, <0.01, <0.01, <0.01, respectively). Compared to non-smoking, current smokers were at a higher risk for mortality [HR (95% CI)=1.3 (1.1-1.5) for total mortality; HR (95% CI)=1.6 (1.1-2.2) for all-cancer mortality; HR (95% CI)=3.9 (1.9-7.7) for lung cancer mortality]. CONCLUSIONS: This study's results suggest that cigarette smoking might be associated with total mortality, all-cancer mortality and especially lung cancer mortality among Korean adults.

A Case of Intraneural Ganglion Associated with Common Peroneal Nerve Palsy

There are few reports on intraneural ganglion, and this malformations mainly occurs in peripheral nerves of the upper and lower extremities. In the lower extremity, it often occurs in the common peroneal nerve, with neurologic symptoms such as motor weakness and sensory changes. We experienced a case of intraneural ganglion of the common peroneal nerve around the fibular head and this was associated with neurologic symptoms, including weakness of the motor power in the ankle and great toe dorsiflexion and sensory change in the foot dorsum. It was successfully treated by complete excision. We report here on this unusual case and we review the relevant literature.

Xenografted Tumorigenesis in the oral vestibule of nude mice by Snail transfection: Histological and immunohistochemical study

PURPOSE: The purpose of this study is to investigate the epithelial-mesenchymal transition (EMT) induced by Snail transcription factor and Snailtransfected in vivo tumors with histopathological features. MATERIALS AND METHODS: We induced in vivo xenografted tumorigenesis in the oral vestibules of nude mice by a Snail transfected HaCaT cell line and investigated morphological and immunohistochemical features in Snail expressive tumors. RESULTS: We identified tumor masses in 14 out of 15 nude mice in the HaCaT-Snail cell inoculation group, but no tumors were present in any of the HaCaT cell inoculation group. Induced tumors showed features of poorly differentiated carcinoma with invasion to neighboring muscles and bones. The HaCaT-Snail tumors showed decreased expressions of E-cadherin and cytokeratin, but showed increased expressions of vimentin and N-cadherin. DISCUSSION: The Snail transfected xenograft can improve productivity of malignant tumors, show various histopathological features including invasive growth, and aid in the investigation of tumor progression and the interaction with surrounding tissues.

A Korean Female Patient with Thiamine-responsive Pyruvate Dehydrogenase Complex Deficiency Due to a Novel Point Mutation (Y161C)in the PDHA1 Gene

Pyruvate dehydrogenase complex (PDHC) deficiency is mostly due to mutations in the X-linked E1alpha subunit gene (PDHA1). Some of the patients with PDHC deficiency showed clinical improvements with thiamine treatment. We report the results of biochemical and molecular analysis in a female patient with lactic acidemia. The PDHC activity was assayed at different concentrations of thiamine pyrophosphate (TPP). The PDHC activity showed null activity at low TPP concentration (1 x 10(-3) mM), but significantly increased at a high TPP concentration (1 mM). Sequencing analysis of PDHA1 gene of the patient revealed a substitution of cysteine for tyrosine at position 161 (Y161C). Thiamine treatment resulted in reduction of the patient's serum lactate concentration and dramatic clinical improvement. Biochemical, molecular, and clinical data suggest that this patient has a thiamine-responsive PDHC deficiency due to a novel mutation, Y161C. Therefore, to detect the thiamine responsiveness it is necessary to measure activities of PDHC not only at high but also at low concentration of TPP.

Immunohistochemical study on expression of MMP-2 and MMP-9 in irritation fibroma, oral leukoplakia and oral squamous cell carcinoma

MMP-2 and MMP-9, type IV collagenases which degrade basement membrane, have been known to play important roles in invasion and metastasis of tumor cells, In addition, they seem to be involved in cell differentiation, apoptosis, angiogenesis and immunity, etc. We immunohistochemically examined epithelial and stromal expressions of MMP-2 and MMP-9 in irritation fibroma, oral leukoplakia, and oral squamous cell carcinoma (OSCC) and have some results as follows: 1. Irritation fibromas, oral leukoplakias and OSCCs mostly showed increased expression of MMP-2 and MMP-9 in the epithelium and connective tissue compared with normal mucosa. 2. There was a significant difference in the epithelial expression of MMP-2 and MMP-9 between irritation fibroma and oral leukoplakia. 3. There was a significant difference in the epithelial and stromal expression of MMP-2 and MMP-9 between irritation fibroma and OSCC. 4. There was a significant difference in the stromal expression of MMP-9 between oral leukoplakia and OSCC. We concluded that rritation fibroma, oral leukoplakia and OSCC have somewhat different characteristics of MMP-2 and MMP-9 expressions, which perhaps result from different pathogenesis.

Hypothalamic-Pituitary-Adrenal Reactivity in Boys with Attention Deficit Hyperactivity Disorder

The hypothesis 'whether subjects with attention-deficit/ hyperactivity disorder (ADHD), who showed under-reactivity of the hypothalamic-pituitary-adrenal (HPA) axis to stress, would make more commission errors in attention tasks', was examined. Forty-three boys, with ADHD, who visited the psychiatric outpatient clinic, at Kangbuk Samsung Hospital, were the subjects of this study. Both pre- and post-test morning saliva samples were collected from the patients at the Korean Educational Development Institute-Wechsler Intelligence Scale for Children (KEDI-WISC), and Tests of Variables of Attention (T.O.V.A.) performed. The Standard scores of the T.O.V.A were compared between the patients with decreases, or increases, in the salivary cortisol levels after the test. Decreases, or increases in the salivary cortisol levels after the test were shown in 28 and 15 patients, respectively. The patients with decreased cortisol levels after the test tended to make more commission errors in compared with those with increased cortisol levels. The patients with the decreased cortisol levels after test had more omission errors in the first quarter of the test, and more commission errors in the second half of the test compared to those with the increased cotisol levels. Subjects who show decreased salivary cortisol levels after stress make more commission errors in attention tests. This suggests that the blunted HPA axis response to stress is related to the impulsivity in patients with ADHD.

Neurophysiological Measurement of Alcohol Craving Using Visual Event-Related Potential / 신경정신의학

OBJECTIVES: Alcohol craving, is not only the most common symptom but the key element in alcohol dependence. The aim of this study is to measure ERPs, especially P3 elicted by alcohol related photographs in order to assess the craving in alcohol dependent patients. METHODS: Based on the result of previous study, 6 alcohol related photographs and 6 control photographs were chosen as visual stimuli. Each stimuli set consisted of alcohol related or control photographs as target stimuli and the same sized checkerboards as non-targets. Stimuli were presented using oddball paradigm for 300 msec with an inter-stimulus interval of 1000 msec in 12 normal controls and 16 abstinent alcohol dependent patients. One session consisted of three blocks; exercise block, control block, alcohol craving block. RESULTS: The amplitudes of P3 elicited by alcohol related visual stimuli were significantly larger than those of P3 elicited by control stimuli in alcohol dependent patients while there was no significant difference in normal controls. CONCLUSION: Consistent with the hypothesis, only alcohol-dependent patients were characterized by increased P3 amplitude associated with alcohol-realted visual stimuli compared with control stimuli. The results suggest the ERPs can be used as a neurophysiological correlate of alcohol craving in alcohol dependent patients. Future investigations will be needed to assess the relapse in the patients included in this study in order to elucidate the meaning of the increased P3 amplitude.

Maternal Depression and Anxiety and Ratings of Behavioral Problems of Child / 신경정신의학

OBJECTIVES: This study was aimed to investigate the relationship between maternal depression and anxiety, and their ratings of child's behavior. METHODS: 769 elementary school students participated in this study. Mothers completed the Korean Conners' Parent Rating Scale (K-CPRS), the Korean Attention-deficit/hyperactivity disorder Rating Scale (K-ARS): Home Version, the Korean Beck Depression Inventory (K-BDI) and the Korean Beck Anxiety Inventory (K-BAI). Teachers completed the Korean Conners' Teacher Rating Scale (K-CTRS) and the K-ARS: School Version. The maternal emotional status was classified into four groups (Normal, Anxious and Not Depressed, Depressed and Not Anxious, Anxious and Depressed) according to BDI and BAI scores. The subscale raw scores of K-CPRS, and K-ARS: Home version were compared among maternal emotional status by the Analysis of Covariance before and after their scores were controlled for the each subscale scores rated by teachers consistent with those rated by parents. RESULTS: All of the subscale scores of parent's form were significantly different according to maternal emotional status after controlled for the scores of teacher's form. After post hoc analysis, the scores of parents' ratings of Anxious and Not Depressed group and Anxious and Depressed group were higher than those of the Normal group. CONCLUSION: The mothers who are depressed and/or anxious tend to report more behavior problems of children than now they actually are.

The Amino Acid Compositions of Formula for Children with Inherited Metabolic Disorder

PURPOSE: This study aimed to determine the amino acids composition, safety and efficacy of formulas recently developed by Korean dairy companies for children with inherited metabolic disorder. METHODS: The determination of amino acids concentration was performed on eight Korean formula samples. The samples were hydrolyzed with 6N HCL or performic acid and analyzed by amino acid analyzer. RESULTS: No phenylalanine, methionine or leucine was observed in PKU-1 and PKU-2 Formulas, Methionine-Free and Leucine-Free Formula, respectively. BCAA-Free Formula was free from leucine, isoleucine, and valine and MPA Formula did not contain methionine and valine. Protein-Free formula did not include any amino acids. UCD Formula contained arginine but was free of alanine, aspartic acid, glutamic acid, glycine, histidine, proline and serine. Methionine-Free Formula contained higher amounts of cystine and tyrosine was higher in PKU-1 and 2 Formulas. The amounts of isoleucine and threonine were minimal in MPA Formula. CONCLUSION: This study confirmed that the eight special formulas, developed for the first time by a Korean dairy company for children with inherited metabolic disorder contain appropriate amino acids with proper contents. Both the total amino acid amounts and specific amino acid concentrations of the formulas were appropriate for related diseases, which could be used safely by the patients with inherited metabolic disorder. For UCD Formula that contains arginine, we suggest that arginine be removed from the formula in order to use for any urea cycle defect patients before the specific diagnosis is made.

Clinical Nurses' lived Experience of Interpersonal Relations in the Ward Setting of the hospital / 간호학회지

PURPOSE: The purpose of the study was to describe the essential structure of the lived experience of clinical nurses' interpersonal relations among nurses, patients, and others in the ward setting of the hospital. METHOD: Six nurses who have experienced from 4 to 7 years on the same ward setting, were interviewed. The data were collected from September, 2000 to May, 2001 and analyzed using Colaizzi's (1978) method of phenomenology. RESULT: In this study, 7 themes were extracted: difficulty of interpersonal relations after being familiar with work, developing good relations with doctors, patients, and their significant others as experience increased, generation gap among individual nurses, evaluating other nursing colleagues on their past experience in ward settings, avoiding nurses with whom one was in conflict, sometimes, resolving conflict through getting together with colleagues informally, having a limited interpersonal network, experiencing becoming mature through struggling with the difficulty of interpersonal relations. CONCLUSION: Nurse managers need to provide resources, opportunities, and information to clinical nurses through fully understanding the characteristics of nurses' interpersonal relations. In addition, they should minimize the factors which intervene with good interpersonal relations among clinical nurses.

The Correlation between Outcome and Ultrasonographic Findingsin Congenital Muscular Torticollis

OBJECTIVE: The ultrasonographic (US) findings of the sternoocleidomastoid muscles (SCM) in patients with congenital torticollis were studied to evaluate the correlation between the US findings and outcome of physical theraphy. METHOD: We studied 52 patients diagnosed as congenital muscular torticollis. We evaluated the thickness, mass, echogenicity and echotexture of both SCM muscles. The US findings of the SCM muscles were divided into 5 grades according to the severity. The physical theraphy included heat theraphy and passive stretching of involved muscle. The outcomes of the treatment were evaluated by physical examination and follow-up US examination. RESULTS: Neck rotation of lesion site comparing to non-lesion site was improved significantly from 83.0+/-16.5% to 94.9+/-7.16% and lateral flexion from 77.9+/-18.1% to 90.5+/-12.4% after the treatment. In 20 US follow-up cases, thickness ratio of the involved SCM muscle decreased significantly from 177.8+/-46.2% to 158.3+/-83.1%. The therapeutic effect tends to be low with higher grades of the US findings. But, there were no significant statistical correlation between age and treatment outcome. CONCLUSION: The US findings of the SCM muscles had a significant correlation with the outcome and the duration of treatment.