The Comparison of Clinical Variables Among Competitive Employment, Partial Employment, and Unemployment Group in Schizophrenic Outpatients / 신경정신의학

Objectives@#The purpose of this research was to examine differences between clinical variables among outpatients with schizophrenia in competitive and partial employed and unemployed groups. @*Methods@#The study subjects were 168 outpatients with schizophrenia, and these were divided into three groups, that is, competitive (n=20), partial (n=28), and unemployed (n=120) groups, based on employment status. Job and psychopathology data were collected by interview and using self-report questionnaires (self-stigma, will to recover, family attitude, perceived social support, insight into disease, self-esteem, hopelessness, and attitude to drugs). @*Results@#The proportion of male patients in the competitive employment group was greater than in the partial or unemployed groups. Education level was significantly higher, and the number of hospitalizations was significantly lower in the competitive group than in the unemployed group.Levels of self-stigma, will to recover, and perceived social support were significantly higher, and levels of self-esteem and hopelessness were significantly lower in the competitive and partial employment groups than in the unemployed group. Patients in these two groups also reported a more positive family attitude, more insight into the disease, and a more positive attitude toward drugs than patients in the unemployed group. @*Conclusion@#Most clinical variables were similar in the competitive and partial employment groups.The findings of this study suggest environmental and systematic factors are more important for the employment of outpatients with schizophrenia than disease-associated factors.

Urban-Rural Gap in the Prehospital Delay of Acute Stroke Patients

PURPOSE: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients. METHODS: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term "acute" was defined as 24 hours from symptom recognized. The term "urban" was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system. RESULTS: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas. CONCLUSION: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.

A Case of P-ANCA-Positive Anti-Glomerular Basement Membrane Antibody Disease / 대한내과학회지

Up to 40% of patients with anti-glomerular basement membrane (GBM) disease, which is a rare autoimmune disorder usually manifesting as rapidly progressive glomerulonephritis (RPGN), are positive for circulating anti-neutrophil cytoplasmic antibody (ANCA). Many previous reports showed poor outcomes in these "double-positive" patients. We report a patient with perinuclear (p)-ANCA positive anti-GBM disease who presented with RPGN and required hemodialysis. Plasmapheresis and steroid and cyclophosphamide therapy were initiated following renal biopsy and resulted in normalization of anti-GBM antibody and p-ANCA titers, recovery of renal function, and discontinuation of hemodialysis. This case suggests that aggressive immunosuppression with plasmapheresis in patients who are p-ANCA positive with anti-GBM disease should be considered, even in those with severe renal dysfunction.

A Case of Heterotopic Pancreas in the Ampulla of Vater that Mimicked Distal Common Bile Duct Cancer

Heterotopic pancreas can be defined as the occurrence of pancreatic tissue at aberrant anatomic sites that lack vascular, neural and anatomic community with the pancreas. A minority of heterotopic pancreas elicit clinical signs or symptoms that can vary according to its location and size, and the involvement of the overlying mucosa. We report here on a case of heterotopic pancreas that was removed by pancreatoduodenectomy under the erroneous diagnosis of distal common bile duct cancer.

A Case of Chronic Active Epstein-Barr Virus Infection with Coronary Aneurysm

Chronic active Epstein-Barr virus infection(CAEBV) is a nonfamilial syndrome that shows a specific immunodeficiency for the Epstein-Barr virus(EBV). CAEBV is characterized by fever, lymphadenopathy, splenomegaly, hepatitis, interstitial pneumonitis, interstitial nephritis, and uveitis. Cardiovascular complications are rare in EBV infection. Patients with CAEBV show characteristically high titers of anti-viral capsid antigen(VCA) IgG antibody and anti-early antigen(EA) antibody, as well as relatively low titer of anti-EB nuclear antigen(EBNA) antibody. We experienced a case of CAEBV with giant coronary aneurysms, who was a 6-year-old boy. He had 5 episodes of high fever and cervical lymphadenopathy and hepatosplenomegaly. The 6 mm sized bilateral coronary aneurysms were detected by echocardiography at second admission. IgG antibodies to EBV was positive, whereas negative for IgM antibody. Antibodies to EA and EBNA were also positive. The EBV was detected in lymph node tissue by in situ hybridization, and in the peripheral blood and bone marrow by the PCR. Treatment has been done with ganciclovir and interferon (IFN)-alpa for 5 weeks. The EBV-PCR of peripheral blood was converted to negative from 12th day of treatment. At present he has followed well for two years without fever and enlargements of lymphnode, except large coronary aneurysm.

Flexible Bronchoscopic Finding of Congenital Lobar Emphysema

Congenital lobar emphysema is a rare disease and a cause of respiratory distress in early infancy. The most common location of pulmonary involvement is the left upper lobe. We diagnosed a case of congenital lobar emphysema in a 5-month-old female infant, who had a complex heart disease using flexible bronchoscopy. In spite of palliative heart surgery, respiratory difficulty and cyanosis did not improve and weaning from artificial ventilation was not possible. Chest X-ray and CT scan showed persistent hyperinflation in the left upper lobe. So, we performed flexible bronchoscopy. The findings showed no cartilage and patent bronchus during inspiration, but complete collapse during expiration due to a check valve effect in the left upper lobar bronchus. After excision of the involved lobe, the patient improved from respiratory distress. The observed airway patency during inspiration, and dynamic airway collapse on expiration suggest that bronchomalacia contributed to lung overinflation in this case.

Transarterial Chemoembolization ( TACE ) for Hepatocellular carcinoma: Comparison of Adriamycin alone vs . Cisplatin alone vs . Adriamycin + Cisplatin / 대한암학회지

PURPOSE: Although transarterial chemoembolization (TACE) has been widely used for the treatment of unresectable hepatocellular carcinoma, it has not been determined yet which chemotherapeutic agents were best for TACE. To determine the best chemotherapeutic regimen for TACE, we performed a prospective randomized study comparing 3 chemo- therapeutic regimen (adriamycin alone vs. cisplatin alone vs. adriamycin + cisplatin). MATERIALS AND METHODS: The patients with unresectable hepatocellular carcinoma were eligible for this study and were randomly assigned to three treatment groups (A: adriamycin 30 mg/m(2), B: cisplatin 60 mg/m(2), C: adriamycin 30 mg/m(2) + cisplatin 60 mg/m(2)). The TACE were performed by administering the mixture of lipiodol and the assigned chemotherapeutic drugs through the hepatic artery, followed by embolization with gelfoam powder. The treatment was planned to be repeated every 4 weeks. RESULTS: After 40 patients (14 in group A, 16 in group B, 10 in group C) entered, the study was stopped prematurely because of serious treatment-related complications including 15% of local complications, 18% of hepatic encephalopathy, and 8% of deaths. Because TACE could result in necrosis without reduction of mass size, the response could not be evaluated by the change of mass size, but by the change of serum alpha-fetoprotein level. Of 25 patients who had elevated serum alpha-fetoprotein and were assessable for response, there were one complete response (CR) and 5 partial responses (PR) out of 10 in group A, 5 PRs out of 10 in group B, and 2 PRs out of 5 in group C. There was no difference in response rates among the 3 treatment groups (p > 0.05). The response rate in patients treated with gelform embolization was higher than patients without embolization (63% (12/19) vs 19% (1/6): p<0.05). The median survival (OS) was 23 weeks for all 40 patients, 15 weeks for group A, 42 weeks for group B and 24 weeks for group C. The difference of OS between group A and B was statistically significant (p=0.02). However, the OS was not associated with any prognostic factors including treatment group in multivariate analysis. CONCLUSION: Although cisplatin seemed to be more effective in TACE than adriamycin, no firm conclusion could be drawn from this prematurely ended study. However, we could conclude that the TACE with gelform powder is so toxic that it could not be given safely to the patients with unresectable hepatocellular carcinoma

Comparison of Intravenous Propofol and Midazolam Anesthesia for Outpatient Cystoscopy / 대한마취과학회지

BACKGROUND: Ambulatory surgery has become popular because patients believe it allows them greater control over their business and personal lives and because third party payers find it reduces cost. This study was designed to compare the characteristics of induction and recovery as well as the safety of propofol with those of midazolam used for intravenous anesthesia in outpatient cystoscopy. METHODS: 56 healthy consenting outpatients were randomly assigned to receive either bolus of propofol (2 mg/kg, n=29) or midazolam (0.1 mg/kg, n=27) for anesthesia in outpatients cystoscopic procedure. All patients also received bolus of fentanyl 1ug/kg before induction and N-M blocking agent was not injected for maintenance of spontaneous respiration. Mean arterial pressure, HR and SpO2 were recorded and induction time (time to spontaneous eye closure), recovery time (time to response, time to orientation, time to ambulation) and adverse effects were evaluated. RESULTS: The results were as follows; 1) Both propofol and midazolam produced smooth induction, but caused significant respiratory depression. 2) The time of induction and postoperative recovery (time to ambulation) was faster in propofol than in midazolam. 3) There were less postoperative side effects (nausea, vomiting, dizziness) in propofol than in midazolam. 4) There were more cardiovascular depression in propofol than in midazolam. CONCLUSION: These results suggest 1) that propofol has significant advantage over midazolam in outpatient surgery, where early ambulation and discharge is desirable and 2) that both propofol and midazolam should be administered by expert anesthesiologist only when ventilatory assistant device with oxygen is immediately available.

A Case of Transfusion Complication under General Anesthesis / 대한마취과학회지

Transfusion complications include ABO/Rh incompatibility, sepsis, febrile reaction, immunosuppression, and viral transmission. We experienced a case of anaphylactic reaction in a 40-year-old male scheduled for laminectomy. Anesthesia was induced by intravenous (I.V.) thiopental sodium and maintained with enflurane / N2O / oxygen. Vital signs were stable until 2 hours into surgery, when patient developed sudden profound hypotension (systolic pressure 60 mmHg) with tachycardia, skin flushing and bronchial wheezing shortly after infusion of only a few milliliters of 4th unit of whole blood. Blood transfusion was immediately stopped, anesthetic agents were discontinued, and 100% oxygen was administered. Rapid administration of I.V. fluids was begun and I.V. hydrocortisone along with pheniramine were administered. Patient was successfully treated and eventually discharged from the hospital. In conclusion, besides hemolytic transfusion reaction, anaphylactic transfusion reaction may cause severe hypotension. One should be aware of the potential for adverse effects including anaphylaxis, should recognize them immediately and treat them appropriately.

Well-Differentiated Papillary Mesothelioma of the Peritoneum: Report of a case

We described a case of well differentiated papillary mesothelioma (WDPM) of the peritoneum in a 68-year-old man because of its rarity. It was incidentally found during operation for renal cell carcinoma. Grossly, the tumor appeared as multiple small granules or nodules on the entire peritoneal surface, including serosa of the intestine, omentum and mesentery. Microscopically, characteristic features are papillary, tubulopapillary or solid architecture lined by single layer of uniform, cytologically bland, cuboidal or polygonal mesothelial cells. The tumor cells were positive for EMA, cytokeratin and vimentin, but negative for CEA on immunohistochemical staining. Ultrastructural study showed characteristic long slender microvilli on the surface and intercellular junctions.

Partial remission with transarterial embolization in a case of metastatic adrenal cortical carcinoma

A case of metastatic adrenal cortical carcinoma in which partial remission was achieved with transarterial embolization is presented as probably the first reported case in the literature to date. A 29-year-old woman was admitted because of adrenal cortical carcinoma which had not responded to mitotane. A left adrenalectomy with segmentectomy of the involved liver had been done previously. Abdominal computerized tomography demonstrated multiple large metastatic tumors in the liver. Transarterial embolization with Gelfoam and 20 mCi of 131I-labeled lipiodol was performed and resulted in a decrease in tumor size and biochemical parameters. Transarterial embolization can be one of the therapeutic modalities for metastatic adrenal cortical carcinomas.

Clinical Trial of Low Level Laser Therapy in 20 Patients with Postherpetic Neuralgia / 대한피부과학회지

Postherpetic neuralgia(PHN) can be extremely debilitating condition. Treatment protocols for PHX may vary from center to center, such as conservative and intensive supportive therapeutic regimens, for example, oral medication, cutaneous nerve stimulating therapy, even acupuncture and hypnotherapy have been stressec In spite of all these measures, some 15% of PHN suffers gain little or no ra lief. Anecdotal reports have suggested that low level laser therapy(LLLT) is effective in the relief of various types of neuralgia. Rased on these, we were interested to apply LLLT for crucial condition of PHN. This is a prelirninary clinical trial to evaluate the efficacy of LLLT in the treatment of the pain for well established and unrelieved PHN. In order to get more accurate result, subjective and objective criteria. were applied. The cases who showed the effectiveness in criteria of Excellent were 6/20(30 %) the cases who showed the effectiveness in criteria of Good were 3/20(15%), and the cases who showed the effectiveness in criteria of Fair were 3/20(15%). So the total cases who showed onset of the effectiveness of LLLT were 12 out of 20 cases(60%).

Transthoracic Fine Needle Aspiration Cytology: Review of 213 cases

A total of 213 fine needle aspirations from pulmonary lesions in 193 patients performed from January, 1986 to March, 1989 were analyzed. The cytologic diagnoses were unsatisfactory in 10, negative in 60, atypical in 6, suspicious in 11 and malignant in 126 cases. The cytologic types of the malignant cases were 47 squamous cell carcinomas, 40 adenocarcinomas, 10 small cell carcinomas, 6 large cell carcinomas and 10 metastatic tumors. They were verified by the histologic confirmation in 31 cases and by the clinical data in the remainder. There were 5 false-negative cases and none was false-positive, representing 96% sensitivity and 100% specificity. Primary lung cancers were accurately typed in 73% of histologically confirmed case. Cell blocks, prepared in 99 cases, were helpful in tumor typing of 11 cases.

An Epiderniological Study of Contact Dermatitis: I . Multicenter Trials / 대한피부과학회지

The present work is the first joint epidermiological study of contact dermatitis carried out by the Korean Contact Dermatitis Research Group which was organized in 15i8p. For the past 2 years total 937 patients with contact dermatitie and suspected contact dermatitis have been routinely patch tested with Hollister-Stier standard battery (28 different antigens) by using Finn Chamber at 10 different General Hospitals which were located around Seoul area. The MOHL index was quite different from the western data, which was characterized with less male, rare leg ulcer and less occupational cases. However, housewife hand eczema cases were more common. The most common senaitiaers were ammoniated mercury, nickel sulfate, potassium dichromate, cinnamic alcohol, neomycin sulfate, paraphenylendiamine, balsam of Peru and thimerosal in order of frequency.

Water Content of Stratum Corneum in Healthy Individuals and Leprosy Patients / 대한피부과학회지

We evaluate the water content, hygroscopicity and water holding capacity in 40 healthy individuals and 17 leprosy patients by skin surface hydrometer(IBS Inc, Japan), and the correlation between the nerve destruction and the hydration state. In Eiealthy individuals the measuring sites were the flexor and extensor surfaces of the arm, forearm, thigh and leg, In leprosy patients we measured on the extensor surface of forearm with shows abnormal sensation, and opposite ar neighboring skin which shows normal sensation. The results are as follows: 1. The water content of healthy individuals is highest in the flexor surface af arm (49. 50 + 18.38ug ) and lowest in the extensor surface of leg(30.75 -12.09ug) 2. The hygrosccpicity of healthy individuals is highest in the flexor surface of arm(296. 30 + 70.75ug ) and lowest in the extensor surface of leg(24$. Q7+5) 5ppg) 3. The water content of the extensor surface of lorearm in leprosy patients, which .hows abnormal sensation, is decreased(16. 35 +20. 82 ug) and it is statisti calli significant when compared with healthy individuals(p<0.005). 4. The hygroscopicity of the extensor surface of forearm in leprosy patients. which shows abnormal sensation, is decreased(94. 29 + 71. 62 ug) and it is statistically significant when compared with opposite or neiphboring skin and healthy individuals(p<0. 005)

Radiologic analysis of total colonic aganglionosis

Radiologic findings of Total colonic Aganglionosis(T.C.A.) were analized in 15 patients with the results asfollows; 1. Male to female ratio was 8:7. 2. There were six cases of small calibered colon, seven cases of normalcolon and two cases of megacolon. 3. Free reflux of barium into the small bowel was observed in seven cases out ofeight in which retrograde filling was tried. 3. Delayed films (24 hrs or more) were available in eight cases andmost of the barium remaned in bowel in six cases. 5. There were abnormal colonic contractions in three cases,decreased redundancy in five and five cases of irregular, hypertrophic mucosal wall suggesting enterocolitis. 6.Part of ileum were also aganglionic in five cases. There seems to be no pathognomonic barium enema findings inT.C.A. But combination of these findings may suggest the possibility of T.C.A. T.C.A. should be considered indifferential diagnosis of bowel obstruction in infants. Barium enema should be complete and delayed films alwaysbe obtained.

Percutaneous needle aspiration and biopsy of localized pulmonlary lesions

Over a period of recent 12 months, 41 patients who had localized pulmonary lesions, but were not diagnosedpathologically through bronchoscopy, transbronchial biopsy, sputum examination and cervical lymph node biopsy,underwent percutaneous needle aspiration and biopsy with a diagnostic accuracy of 83% concerning malignancy vs.benignity and 78% considering the specific cell types as well. Six patients developed small asymptomaticpneumothorax and the other three develped small amount of hemoptysis; One of them required treatement. There were21 malignancies and 14 benign lesions. Three cases were misinterpreted and five were inconclusive on cytology,maybe due to inadequate material. No material was aspirated in one case due to hardness of the mass, which, later,confirmed chondroarcoma on surgery. The method, problems and complications are discussed. Nowadays, thepercutaneous needle aspiration and biopsy appears to be the procedure of choice in pulmonary coin lesionsespecially when they are smaller, more peripheral, and whenever meastatic neoplasm in suspected.

Percutaneous transhepatic biliary drainage in 107 patients

Percutaneous transhepatic biliary drainage has played a major role in treatment of patients with bilairy tractdisease, especially obstruction by malignant disease. Percutaneous transhepatic biliary drainage was performed 128 times in 107 patients of obstructive jaundice for recent 2 years and 8 months from July, 1981 to March, 1984 at departement of radiology, Seol National University Hospital. The resuls were as follows; 1. The male to femaleratio was 2:1 and the age ranged from 19 to 88 with average of 54. 2. The causes of obstructive jaundice included 94 malignant diseases and 13 benign diseases. Malignant diseases were 48 cases of bile duct cancer, 20 cases of metastasis, 20 cases of pancreatic cancer, 4 cases of gallbladder cancer, 1 case of ampulla Vater cancer, and 1case of duodenal cancer. Benign diseases were 8 cases of comon bile duct stone and 3 cases of benign stricture and2 cases of cholangitis. 3. The most common indication was palliative drainage of obstruction secondary to malignant tumor in 78 cases. 4. The overall success rate was 93.7%. Internal drainage was acheved in 34 (26.5%)and external drainage was accomplished 86(67.2%). 5. Decline in serum bilirubin level was found in 100cases(5.6%). Percutaneous transheatpic biliary drainage is a proven technique for non-operative biliarydecompression and established alternative to surgery.

An experimental study on the normal brain microangiography

The study was undertaken to evaluate the normal microangiograhic findings of the brain and to assess the effect of varying perfusion technicque of the microangiography in the rat. All the microvascular structures including fine medullary branches of the perforating arteries and anastomotic capillary netweks are well visualizedin both 15 minutes-pefusion group and 30 minutesperfusion group. But many of the micorvascular structures are notuniformly opacified in the both groups. There is no difference in microangiographic findings between these groups.There is poor perfusion of the micorvascular structures in the 3rd group, the group with perfusion for 30 minuteswithout ligation of aorta below the needle insertion site. The new, simple perfusion technique should be developedto obtain the best quality of the microangiographic findings in the brain of the experimental animals.

Percutaneous needle aspiration biopsy of localized pulmonary lesions

Over a period of recent two years, 100 patients who had localized pulmonary lesions and underwent percutaneousneedle aspiration and biopsy, were analized. There were 56 malignancies and 44 benign and 79% respectively.Differentiation of malignancy vs. benignity was possible in 89% of cases obviating unnecessary exploratorythoracotomy for diagnostic purpose, Five cases were misinterpreted and eight cases were non-diagnostic oncytology. Inadequate materail was obtained in two cases; one was due to hardness of the mass, which, later,confirmed as chondrosarcoma, and the other was too samll(0.8x1.0cm) to be visible on lateral view. Theobainenability of the tissue was 98%. 14(14%) patients developed pneumothorax; one of them required treatment andthe reminder showed spontaneous resporption. (Transient neglibigle blood tinged sputum was found in 16(16%)cases.) The method, problems and complications are discussed. Authors recommend the percutaneous needle aspirationand biopsy as the initial procedure in diagnostic work-up of pulmonary coin lesions, especially when they aresmaller, more peripheral and metastatic neoplasm is neoplasm is suspected.