Health Insurance Issues and Future Prospects Related to Korean Mental Health Care: Adult Mental Health and Hospitalization Services / 신경정신의학

The landscape of mental health services in Korea has evolved due to changes in the payment system. Despite the increasing societal focus on mental health, challenges persist. In 2021, 3622695 patients received treatment for mental and behavioral disorders, but decreasing bed numbers in general hospitals and a shortage of psychiatry specialists posed significant hurdles. Although reimbursements for psychiatry remain modest compared to other medical fields, the proportion of expenses allocated to psychotherapy is rising steadily, indicating a growing demand for mental health services. The Korean psychiatric hospitalization system faces a critical juncture. Inadequate reimbursement rates have led to a reduction in the number of beds in general hospitals, compromising acute psychiatric care. Psychiatric hospitals also suffer from low reimbursements, resulting in substandard care environments. These issues exacerbate the societal challenge of acute mental illness and psychiatric emergencies. Despite the recent regulatory efforts, including facility standards, the underlying problem of a discriminatory payment system persists, disproportionately affecting those with medically insured mental illnesses. Although some positive systemic changes have occurred, establishing an effective acute care system for mental illness remains a distant goal. Additional measures are essential to address the disparities and inadequacies within the current mental health payment system and ensure equitable access to quality care for all individuals with mental health needs.

The Effect of Supplemental Cardioplegia Infusion before Anastomosis in Patients Undergoing Heart Transplantation with Long Ischemic Times

Background@#Prolonged ischemic time is a risk factor for primary graft dysfunction in patients who undergo heart transplantation. We investigated the effect of a supplemental cardioplegia infusion before anastomosis in patients with long ischemic times. @*Methods@#We identified 236 consecutive patients who underwent orthotopic heart transplantation between February 2010 and December 2014. Among them, the patients with total ischemic times of longer than 3 hours (n=59) were categorized based on whether they were administered a complementary cardioplegia solution (CPS) immediately before implantation (CPS+, n=30; CPS−, n=29). @*Results@#The mean total ischemic times in the CPS+ and CPS− groups were 238.1±30.1 minutes and 230.1±28.2 minutes, respectively (p=0.3). The incidence of left ventricular primary graft dysfunction (CPS+, n=6 [20.0%]; CPS−, n=5 [17.2%]; p=0.79) was comparable between the groups. In the Kaplan-Meier survival analysis, no significant difference in overall survival at 5 years was observed between the CPS+ and CPS− groups (83.1%±6.9% vs. 89.7%±5.7%, respectively; log-rank p=0.7). No inter-group differences in early mortality (CPS+, n=0; CPS−, n=1 [3.4%]; p=0.98) or complications were observed. @*Conclusion@#The additional infusion of a cardioplegia solution immediately before implantation in patients with longer ischemic times is a simple, reproducible, and safe procedure. However, we did not observe benefits of this strategy in the present study.

The Association of the 2nd to 4th Digit Ratio with the Age of Onset and Metabolic Factors in Korean Patients with Schizophrenia

OBJECTIVES: The ratio of second to fourth digit length (2D : 4D) could be a potential epigenetic marker of sexual dimorphism reflecting prenatal testosterone exposure. Testosterone is known to affect the development of the brain through an epigenetic mechanism. The purpose of this study was to investigate the effects of exposure to fetal testosterone on the metabolic syndrome based on 2D : 4D of schizophrenia patients and the relationship with the age of onset of schizophrenia. METHODS: A total of 214 schizophrenia patients participated in this study. The participant's physical and blood tests were performed according to the American National Cholesterol Education Program's Third Amendment of the Metabolic Syndrome Diagnostic Criteria, and the 2D : 4D was measured by the method designed by McFadden. Data were statistically analyzed by t-test, Pearson's correlation analysis and multiple regression model analysis. RESULTS: 2D : 4D was significantly higher in female than male in both hands, and there was a statistically significant negative correlation between 2D : 4D and the age of onset of schizophrenia in male. However, 2D : 4D did not show statistically significant correlation with metabolic factors. CONCLUSIONS: Fetal testosterone suggests the possibility of affecting the age of onset of schizophrenia through the epigenetic mechanism, but there is no clear relationship with metabolic factors.

Risk Analysis of the Long-Term Outcomes of the Surgical Closure of Secundum Atrial Septal Defects

BACKGROUND: Closure of a secundum atrial septal defect (ASD) is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction. METHODS: Between October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was 40.9±13.1 years, and 199 (28.7%) were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6%) and significant tricuspid regurgitation (TR) in 137 patients (19.8%). The mean follow-up duration was 12.4±4.7 years. RESULTS: There was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023) and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001) were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518). CONCLUSION: Surgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

Minimally Invasive Approach for Redo Mitral Valve Replacement: No Aortic Cross-Clamping and No Cardioplegia

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.

Minimally Invasive Trans-Mitral Septal Myectomy to Treat Hypertrophic Obstructive Cardiomyopathy

A 43-year-old man with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) was admitted to our hospital with aggravated exertional dyspnea and successfully treated with robotic transmitral septal myectomy. Minimally invasive transmitral septal myectomy may be a feasible surgical option for the treatment of HOCM in selected cases as an alternative to transaortic myectomy.

Prognostic Factors of Hemifacial Spasm after Microvascular Decompression

OBJECTIVE: The factors that influence the prognosis of patients with hemifacial spasm (HFS) treated by microvascular decompression (MVD) have not been definitely established. We report a prospective study evaluating the prognostic factors in patients undergoing MVD for HFS. METHODS: From January 2004 to September 2006, the authors prospectively studied a series of 293 patients who underwent MVD for HFS. We prospectively analyzed a number of variables in order to evaluate the predictive value of independent variables for the prognosis of patients undergoing MVD. The patients were followed-up at regular intervals and divided into as cured and unsatisfactory groups based on symptom relief. Uni- and multivariate analyses were performed using logistic regression models. RESULTS: A total 273 of 293 (94.2%) patients achieved symptom relief within one year after the operation. Intraoperatively, the indentation of the root exit zone was observed in 259 (88.5%) patients. Uni- and multivariate analyses revealed that the symptoms at postoperative 3 months (p<0.001) and indentation of the root exit zone (p=0.036) were associated with good outcomes. CONCLUSION: The intraoperative finding of root exit zone indentation will help physicians determine the prognosis in patients with HFS. To predict the prognosis of HFS, a regular follow-up period of at least 3 months following MVD should be required.

Disseminated Hemangioblastomatosis of the Central Nervous System without von Hippel-Lindau Disease: A Case Report

We report a very rare case of hemangioblastomatosis that developed after surgical removal of a solitary cerebellar hemangioblastoma (HB). A 51-yr-old man presented with back pain 10 yr after undergoing surgery for cerebellar HB. Magnetic resonance imaging showed numerous mass lesions along the entire neuraxis accompanied by prominent leptomeningeal enhancement. Genomic DNA analysis showed no mutation in the von Hippel-Lindau (VHL) genes. A surgical specimen obtained from a lesion in the cauda equina showed pathological findings identical to those of the cerebellar HB that had been resected 10 yr earlier. External beam radiation therapy and radiosurgery were subsequently performed; however, the patient succumbed one year after receiving the diagnosis of hemangioblastomatosis. The reduction of tumor cell spillage during surgery and regular long-term follow-up are recommended for patients with HBs.

A Case of Taste Distortion and Phantogeusia after Tonsillectomy / 대한이비인후과학회지

Dysgeusia after tonsillectomy is a rare complication and there have been a few reports in the literature. The most possible cause of this complication is thought to be direct or indirect injury to the glossopharyngeal nerve or its lingual branch. Other suggested causes are lack of dietary zinc and habitual drug intake. We report a 51-year-old man, who presented severe parageusia and phantogeusia following tonsillectomy that was performed for chronic tonsillitis. The surgery was performed by electrocautery dissection without identifiable injury to the glossopharyngeal nerve. Dysgeusia developed 3 weeks after the operation and he complained loss of appetite and significant weight loss. He did not take any drug habitually that could affect his sense of taste. His serum zinc level (48 microgram/dl, normal range : 61-121 microgram/dl) was decreased. We prescribed a mineral supplement containing vitamin B complex and therapeutic dose of zinc. Eight months after the operation, his taste function was not recovered and he still retained problems related to diet. This case indicates that a patient should be informed of the risk of postoperative taste disturbance after tonsillectomy as being one of the rare complications.

A Case of Relapsing Polychondritis with Inner Ear Symptom Improved by Plasmaphresis / 대한이비인후과학회지

Relapsing polychondritis is a rare disease which often presents itself firstly in the ear, nose and throat (ENT) department. Characteristic features include auricular chondritis, arthritis, nasal chondritis, ocular inflammation, respiratory tract involvement and audiovestibular damage. The mainstay of treatment has been corticosteroid but other agents have been used either alone or in conjunction with it. These other agents include non-steroidal anti-inflammatory agents, dapsone and colchicine which are helpful for mild disease and cyclophosphamide, azathioprine, cyclosporin. Authors have recently experienced a case of relapsing polychondritis in a 32 year old man who had suddenly experienced loss of hearing in his left ear with vertigo. The patient showed no significant improvement with the treatment using steroid and immunosuppressive agents, but showed significant hearing improvement when he was aggressively treated with plasmapheresis. We report this case with a review of the literature.

A Case of Natural Killer T-cell Lymphoma of the Tongue / 대한이비인후과학회지

Malignant lymphoma, which represents about 5.4% of all neoplasms and more significantly 19-28% of malignant neoplasms, is the most common non-epithelial malignancy in the head and neck area and non-Hodgkin's lymphoma accounts for 11.4% of all lymphoma in Koreans. Natural killer/T-cell (NK/T-cell) lymphoma is a lymphoma of the putative natural killer cell lineage. NK/T-cell neoplasms are generally rare, but they are more common in people of the Oriental, Mexican and South American descent. These neoplasms are highly aggressive and they show a strong association with Epstein-Barr virus. The preferential site of extranodal NK/T-cell lymphoma is the nasal cavity and there has been no report of NK/T-cell lymphoma developing from the tongue in the oral cavity. We experienced one rare case of extranasal NK/T-cell lymphoma of the tongue, and to our knowledge, this was the first case in Korea. Thus, we report this case with a review of the literature.