Nature and Extent of Physical Comorbidities Among Korean Patients With Mental Illnesses: Pairwise and Network Analysis Based on Health Insurance Claims Data

Objective@#The nature of physical comorbidities in patients with mental illness may differ according to diagnosis and personal characteristics. We investigated this complexity by conventional logistic regression and network analysis. @*Methods@#A health insurance claims data in Korea was analyzed. For every combination of psychiatric and physical diagnoses, odds ratios were calculated adjusting age and sex. From the patient-diagnosis data, a network of diagnoses was constructed using Jaccard coefficient as the index of comorbidity. @*Results@#In 1,017,024 individuals, 77,447 (7.6%) were diagnosed with mental illnesses. The number of physical diagnoses among them was 11.2, which was 1.6 times higher than non-psychiatric groups. The most noticeable associations were 1) neurotic illnesses with gastrointestinal/pain disorders and 2) dementia with fracture, Parkinson’s disease, and cerebrovascular accidents. Unexpectedly, the diagnosis of metabolic syndrome was only scarcely found in patients with severe mental illnesses (SMIs). However, implicit associations between metabolic syndrome and SMIs were suggested in comorbidity networks. @*Conclusion@#Physical comorbidities in patients with mental illnesses were more extensive than those with other disease categories. However, the result raised questions as to whether the medical resources were being diverted to less serious conditions than more urgent conditions in patients with SMIs.

LINAC-Based Radiosurgery of Arteriovenous Malformation involving Visual Pathway: A Report of Two Cases / 대한뇌혈관외과학회지

The authors present two cases of arteriovenous malformation (AVM) involving the visual pathway following linear accelerator (LINAC) stereotactic radiosurgery. Both patients were treated with 18 Gy (marginal dose, 70-80% isodose line, 3 isocenter) delivered to the malformed vascular mass involving the optic tract on the right side. For both patients, however, less than 8 Gy were irradiated onto the ipsilateral optic chiasm and optic nerve, and 4.5 Gy were irradiated onto the contralateral optic nerve (20% isodose line). On the five-year follow-up MRI scan and angiogram, the AVM was totally obliterated in one patient and the AVM was markedly decreased in size in the other patient. Their visual fields were well preserved and visual acuities were even improved for both patients. We report here with on two cases of AVM involving the visual pathway that were effectively and safely treated with 18 Gy using LINAC-based radiosurgery, and we also attempt to define the safe and effective radiation dosage for the patients with AVM involving visual apparatus.

Analysis of Treatment Results of Vertebral Artery Dissecting Aneurysms Presented with Various Clinical Manifestations

OBJECTIVE: The dissecting aneurysms of vertebral artery with various clinical manifestations have been increasingly reported with recent advent of diagnostic tools such as 3-Dimension computed tomography angiogram, magnetic resonance image and conventional angiogram. The authors analyzed the various treatment modalities according to their clinical presentations of vertebral artery dissecting aneurysms. METHODS: At the author's institution between March 2001 and February 2004, 28 patients were managed under diagnose of vertebral artery dissection. The medical record and neuroimaging studies of patients were reviewed retrospectively. RESULTS: Seven patients were presented with subarchnoid hemorrhage and 2 patients with mass effect. The other 12 patients were presented with ischemic stroke and 7 patients with headache or neck pain. 19 patients were treated with endovascular coils or stent. The other 8 patients were treated conservatively. and one patient was treated with operation. We had no endovascular treatment-related complications. Sixteen patients who underwent endovascular treatment survived with good recovery. but one patient died and 2 patients were in poor neurological status. Among patients with mass effect, one patient was treated with operation. and the other one patient with endovascular coils. We obtained optimal treatment results with improvement of myelopathy in both patients. CONCLUSION: The choice of the treatment of vertebral artery dissecting aneurysm of patients, clinical characteristics, and relation with posterior inferior cererebellar artery. The endovascular treatment using stent with/without coiling could be the treatment of choice if preservation of the vertebral artery is necessory.

A Clinical Study in Nulliparous Women: Age 35 and Older / 대한산부인과학회잡지

OBJECTIVE: To compare pregnancy and delivery complications in first births between women 35 years or older and those who are younger. METHODS: Matemal and newborn records for first births at Chonnam university hospital from January 1, 1988 to December 31, 1996 were studied. The study group included 123 women who were 35 years or older. A control group consisting of 120 younger women was used for comparison. The X2 test was used to identify trends in individual variables and outcomes. RESULTS: Premature rupture of membrane, uterine myoma, and malpresentation were much mare prevalent in the older nullipara. However, there were no significant differences in incidences of preeclampsia, placenta previa, and pyelonephritis between the older nullipara and younger nullipara groups. Older nullipara had a significantly higher incidence of Cesarean delivery than younger women, Elective cesarean section was performed only in the older nullipara and it was the most common indication for Cesarean delivery in older nullipara. Fetal distress and breech presentation as indications for Cesarean delivery were significantly more common in the older study group. There were no noticeable differences in postpartal complication between the groups. Pretam birth and low birth weight were much more common in the older nullipara. but there were no significant differences in small for gestational age, low Apgar score, perinatal morbidity and deaths between the groups. CONCLUSION: From the results, it was difficult to conclude that women 35 or older are pmne to higher risk pregnancies, compared to their younger counterparts. Although more incidences of premature rupture of membrane, preterm delivery, and Cesarean delivery were observed, there were no significant differences in other pregnancy and delivery complications. With appropriate obstetric care, it is most probable that first time pregnancies in older women will result in similar outcome as those in younger women.

Changes of Serum Neopterin and Elastase - alpha1 - Antitrypsin / 대한피부과학회지

BACKGROUND: Generalized immune aetivation occurs early in the course of many infectious diseases. Clinical investigations have known that immune activation can be qiantified by the measurement of soluble immune activation products, neopterin and elastase-a-antitypsm in serum. OBJECTIVE: The purpose of this study was to assess macrophage and neutrophil activation in patient with leprosy by measurement of neopterin and elhstase-a-antitrypin. METHODS: The study population consisted of 31 patients with subculoid leprosy and 71 patients with lepromatous leprosy (39 cases of M. leprae positive patients and 32 cases of M. leprce negative patients). Serum samples and clinical and laboratory data were collected form each patient and control. The levels of serum neopterin and elastase-a-antitrypsin were masured by a sandwich enzyme immunoassay. RESULTS: The serum neopterin levels were significantly raised in patients with leprosy and significantly higher in lepromatous leprosy than tuberculoid leprosy. The sejum elastase-a-antitrypsin levels were significantly increased in pat,ients with leprosy, but did not vary significantly between tuberculoid and lepramatous leprosy. There was also no significant correlation between the neopterin and elastase-a-antitrypsin levels and bacterial index in patients with lepromatous prosy. CONCLUSION: These data suggest that non-specific activation of macrophages and neutrophiles occurs in leprosy and high titers of ineopterin and elastase-a-antitrypsin alore, in the absenee of a functioning T cell response, do not appee,r to confer resistance against Mycobacterium leprae.

Changes of Serum Neopterin and Elastase - alpha1 - Antitrypsin / 대한피부과학회지

BACKGROUND: Generalized immune aetivation occurs early in the course of many infectious diseases. Clinical investigations have known that immune activation can be qiantified by the measurement of soluble immune activation products, neopterin and elastase-a-antitypsm in serum. OBJECTIVE: The purpose of this study was to assess macrophage and neutrophil activation in patient with leprosy by measurement of neopterin and elhstase-a-antitrypin. METHODS: The study population consisted of 31 patients with subculoid leprosy and 71 patients with lepromatous leprosy (39 cases of M. leprae positive patients and 32 cases of M. leprce negative patients). Serum samples and clinical and laboratory data were collected form each patient and control. The levels of serum neopterin and elastase-a-antitrypsin were masured by a sandwich enzyme immunoassay. RESULTS: The serum neopterin levels were significantly raised in patients with leprosy and significantly higher in lepromatous leprosy than tuberculoid leprosy. The sejum elastase-a-antitrypsin levels were significantly increased in pat,ients with leprosy, but did not vary significantly between tuberculoid and lepramatous leprosy. There was also no significant correlation between the neopterin and elastase-a-antitrypsin levels and bacterial index in patients with lepromatous prosy. CONCLUSION: These data suggest that non-specific activation of macrophages and neutrophiles occurs in leprosy and high titers of ineopterin and elastase-a-antitrypsin alore, in the absenee of a functioning T cell response, do not appee,r to confer resistance against Mycobacterium leprae.

Primary sclerosing cholangitis

No abstract available.

CT findings of polymorphic reticulosis: 5 case reports

Five cases of histologically proven polymorphic reticulosis were examined with computed tomography(CT). CT findings were mucosal thickening along the septal and lateral walls of the nasal cavities(n=4), obliteration of the contour of the nasopharynx(n=4), involvement of the paranasal sinuses (n=2), destruction of the nasal septum and/or sinus walls(n=3) and mass in the palate, tonsil or neck (n=1). CT examination was helpful in determining the extent of the disease in the nasal cavity and paranasal sinuses. However, lesions in the palate and tonsils could not be easily evaluated with CT. CT findings of polymorphic reticulosis are nonspecific and granulomatous diseases may show similar CT findings.

A clinical analysis for the operative indications of peptic ulcer disease before and after having been used histamine antagonist

No abstract available.

CT findings of nosomaxillary lesions: differential diagnosis by adjacent bony abnormality on CT

No abstract available.

Correlation of plain film and computed tomography findings of lobar atelectasis

No abstract available.

Value of infusion-DSA(digital subtraction angiography) in diagnosis of primary hepatocellular carcinoma

No abstract available.

Changes of Histopathological Findings with Time in the Dermographism Lesion / 대한피부과학회지

Changes of histopathological findings with time were studied after scratching the skin of 37 patients with dermographism. Biopsies were also done in 13 normal healthy controls for comparison with unstroked skin of the patients. 1. Biopsies of unscratched skin of the patients showed no histologic difference from those of the skin from controls. 2. Neutrophils increased in number with time after scratching and maximum neutrophil count (mean 16.08+/-24.17/HPF) was observed at 90 minutes after scratching 3. Eosinophilic infiltration was also similar to that of neutrophils. Maximum eosinophil count (mean 324+/-4.76/HPF) was found at 60 minutes after scratching. 4. L ymphohistiocytic infiltration showed a similar tendency to that of neutrophils, but the degree of change was not so prorninent. 5. Before scratching, mast cell count in patients with dermographism showed no difference in number when compared with norrnal controls. In patients with dermographism, mast; cell count inclined to decrease after scratching. 6. Edema and lymphatic dilatation in the upper dermis were most prominent at 5 minutes after scratching and disappeared slowly thereafter.

Multiple Cutaneous Focal Mucinosis with Dermatomal Distribution

We report a case of multiple cutaneous focal mucinosis in a 22 year-old male, who presented with multiple, asymptomatic, nodular lesions on the left upper trunk and left arm which had persisted for about one year. They were 2 to 17 mm in size, firm, yellowish, dome-shaped elevated, slightly movable papules or nodules which were distributed over the area of the left C3-7 and TI-3 sensory dermatomes. The histopathologic findings showed homogeneous mucinous material in the upper dermis. The material was confirmed to be hyaluronic add by, alcian blue stain. Some of the lesions showed improvement with intmlesional injection of triamcinolone acetonide. Such an entity, to the best of our knowledge, has not yet been reported.

Color Doppler Assessment of Mitral Regurgitation in Childhood

No abstract available.

A Case of Congenital Generalized Linear Porokeratosis / 대한피부과학회지

Linear porokeratosis is a rare variant of porokerstosis and usually occurs after childhood. We report herein a case of linesr porokeratosis in an 18-year-old female. The lesions had developed since birth and were found on the nearly whole body, including the face, neck, axilla, chest, abdomen, back, and upper and lower extremities. Palms and soles were also affected. Biopsy specirnens from the left forearm and right sole showed typical cornoid lamellae. We could not see any improvement with a course of oral etretinate for 6 weeks.

A Case of Vesicular Pemphigoid / 대한피부과학회지

We report herein a case of vesicular pemphigoid in a 39 year-old female, who had 1 month history of multiple, pruritic vesicles with erythematous maeules on the whole body, especielly on the flexural surface. The histological findings showed subepidermal vesicle which contained many neutrophils. Direct immvnofluorescent study of perilesional skin revealed linear deposits of C along the dermoepidermal junction and indirect immunofluorescent study revealed linear deposits of immunoglobulin G and Cy along the dermoepidermal junction. Initially, dapsone was tried without any benefit but skin lesions were controlled by a combination therapy of prednisolone and cyclphosphamide.

A Case of acquired Digital Fibrokeratoma Arising from the Nail Bed / 대한피부과학회지

Acquired digital fibrokeratomas are uncommon, benign, acquired, firm, more or less hyperkeratotic projections, arising most frequently from the fingers but rarely from the nail beds. We experienced a case of acquired digital fibrokeratoma arising from the nail bed of the left 4th toe in a 20-year-old female.

Computed tomographic findings of intrahepatic peripheral cholangiocarcinoma

Cholangiocarcinoma is synonymous with bile duct carcinoma, and can originate in a small intrahepatic bileduct(peripheral type), a major intrahepatic duct including the hepatic hilus, an extrahepatic duct, or near thepapilla of Vater(central type). In a sense bile duct carcinoma of the peripheral type is cholangiocarcinoma of theliver; it has the same gross configuration as hepatocellular carcinoma, resulting in difficulty to differentiateon the CT. The authors studied CT findings of 14 cases of pathologically proven peripheral type cholangiocarcinomaof the liver during the last 4 years. The results were as follows: 1. Of 14 cases, 8 were female and 6 were male,and the age ranged from 5th to 7th decades. 2. Preoperative clinical diagnosis were as follows: hepatoma 8 cases,abscess 5 cases and metastasis 1 case in order of frequency. 3. Diagnosis were confirmed by hepatic lobectomy in 7cases, wedge resection in 5 cases and needle biopsy in 2 case. 4. Labratory findings were not specific, but therewere only 2 cases with elevated alpha-fetoprotein level. 5. Associated diseases were gallstones in 1 case,intrahepatic duct stones, in 1 case, extrahepatic duct stones in 2 cases, acute or chronic cholecystitis in 5cases and CS in 3 cases. 6. Angiographic and scintigraphic findings were helpful in differential diagnosis fromhepatoma but ultrasonography was non-specific. 7. The number of tumor were solitary in 12 cases and multiple in 2cases. Among solitary cases, the site of involvement of the liver were right lobe in 8 cases and left lobe in 4cases. 8. Common CT features of the intrahepatic peripheral cholangiocarcinoma of the liver were irregular,inhomogeneous, occasionally peripherally enhancing, low density liver mass, frequently accompained by diffuse orsegmental dilatation of the intrahepatic bile duct. If there were normal alphafetoprotein level, positive skinand/or stool examination for CS and difuse or segmental dilatation of the intrahepatic duct in low density livertumor on the CT, one should consider peripheral cholangiocarcinoma of the liver than hepatoma.

Clinical and cholangiographic evaluation of bile duct carcinoma

40 cases of bile duct carcinoma gathered over a 6-year period at Kosin Medical College were reviewed and theirclinical and cholangiographic findings were as follows: 1. There were 29 males and 11 females (the ratio of men towomen, 2.6:1) ranging from 37 to 74 years of age. The majority (70% of cases) were in 4th & 5th decades. 2.Clinical symptoms and signs: jaundice in 95%, RUQ or epigastric pain in 75%, pruritus in 52.5%, dark urine in 35%,weight loss in 32.5%, fever and chills in 22.5%, clay colored stool in 12.5%, and palpable mass in 12.5%. 3.Lab,findings: elevated serum total bilirubin(above 20.0mg% in 45%, 10.0-19.0mg% in 22.5%, 5.0-9.9mg% in 20%,1.3-4,9mg% in 5%), elevated alkaline phosphatase in 95%. Clonorchiasis were noted in 17.5%. 4. Histologic findingswere adenocarcinoma in most cases. 5. The location of bile duct carcinoma were common hepatic duct in 35%, commonbile duct in 32.5%, porta hepatis in 12.5%, junction with cystic duct in 10% and diffuse form in 10%. 6. In 33cases, PTC or post-operative cholangiographic examination were done. And the most frequent findings weredilatation of the proximal bile duct and abrupt narrowing or complete obstruction of distal lumen. In 27cases(82%), complete obstruction of bile duct was noted. Attempts were made to analyze the type of obstruction:Constricted type in 39%, Nipple type in 18%, round or flat type (smooth or slightly irregular) in 15%, andserratd type in 9%. Incomplete obstruction were noted in 6 cases(18%). Among them, abrupt narrowing of lumen wasnoted in 9% and diffuse narrowing in 9%. 7. ERCP was done in 7 cases. Findings were constricted type in 42.6%,constricted and slightly irregular type in 14.3%, downward convexity in 14.3%, diffuse irregular narrowing in14.3% and intraluminal filling defect in 14.3%.