Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea

OBJECTIVE: We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data. METHODS: To examine the diagnostic incidence, we selected patients who were under 10-year-old and who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for RAD (F94.1 and F94.2) and who had not been diagnosed in the previous 360 days, from 2010 to 2012. In this study, we used the term ‘reactive attachment disorder’ representing for both RAD per se and Disinhibited social engagement disorder. Comorbid disorders were categorized according to ICD-10. RESULTS: Among 14,029,571, the total population under 10-year-old during 2010–2012, incident cases of RAD were 736. The mean diagnostic incidence of RAD was 5.25 per 100,000 annually. Language disorders (F80-84) were the most common psychiatric comorbidities in both boys and girls in age groups 0–3 years and 4–6 years, and attention deficit hyperactivity disorder was the most common in both sex aged 7–9 years. In non-psychiatric comorbidities, diseases of the respiratory system (J00–99) were the commonest in both sex in all age groups, and diseases of the digestive system (K00–99) were the next. CONCLUSION: RAD was very rare in practice and would be disguised as other psychiatric disorders. Children with RAD might have more medical comorbidities than typically developed children.

Burr Hole Drainage with Urokinase Irrigation for the Treatment of Acute Subdural Hematoma: A Case Report / 대한신경손상학회지

We describe the case of a patient with an acute subdural hematoma (SDH) that was removed using urokinase irrigation after burr hole trephination in a limited situation where craniotomy was not possible. A 90-year-old woman was admitted to our hospital with a stuporous mental status. Computed tomography (CT) scans revealed a chronic SDH, and a burr hole procedure was performed. The patient's postoperative progression was good until the third day after surgery when we found that the acute SDH had increased on CT scans. The patient's guardian refused further surgery, and thus we drained the blood from the hematoma by injecting urokinase through a drainage catheter. We used urokinase for two days, and removed the catheter after confirming via CT scans that the hematoma was almost alleviated. The patient recovered gradually; she was discharged with few neurological deficits.

Is Sorting Hat in Harry Potter Identity Identifier for Adolescents?

This study analyzes the role of the Sorting Hat in structuring the identity of the characters in the Harry Potter series written by J. K. Rowling. In the different stages of adolescence, one explores and re-establishes one's identity. One's sense of identity is determined by the commitments made regarding personal and social traits. However, it is difficult to establish a concrete identity formation process theory that is communicable to adolescents. In Harry Potter, the characters' identities are reflected upon the Sorting Hat and are continuously molded throughout the book. The Sorting Hat provides nurturing experiences based on temperament. Based primarily on their temperament, it sorts the students into four houses, each with their own distinct characteristics. Once sorted, the houses become the living and learning communities in which the students share the same dormitory and classes until their graduation. Within the community, the students seek connections, supportive relationships, and understanding within the group. The taking on of the group identity is an explanatory variable in the formation of individual identity. The Sorting Hat provides the students with stability and a safe boundary. After being sorted based on their temperament, the inexperienced and immature adolescents can explore different options under the guidance of the Hat before making a definite commitment. By presenting them with an appropriate environment (such as a mentor, friend, or family member), the Hat further shapes their identity and integrates the identity elements ascribed in the beginning. By providing experiences and interactions based on their unique temperament and environment, the Sorting Hat plays a crucial role in establishing the students' identities. The Sorting Hat can be an ideal model for finding one's identity during adolescence.

Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data

Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010–2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.

Comparison of Adults with Attention-Deficit Hyperactivity Disorder Depending on the Age of Being Diagnosed in Childhood and Adulthood: Based on Retrospective Review in One University Hospital

OBJECTIVES: The study aimed to identify the characteristics of attention-deficit hyperactivity disorder (ADHD) that was not diagnosed in childhood or adolescence, but only in adulthood. METHODS: The characteristics of patients diagnosed with ADHD in adulthood were compared with those of patients diagnosed in childhood were assessed via a retrospective review of the medical records at one university hospital from 2005 to 2013. If the age at which they were confirmed as having ADHD was less than 19 years old, they were grouped as childhood-diagnosed group (CD); if they were 19 years old or more, they were grouped as adulthood-diagnosed group (AD). RESULTS: The CD and AD included 50 (46.3%) and 58 (53.7%) patients, respectively. Inattention was the most common symptom in both groups. Behavioral and emotional problems were the second most frequent symptoms in the CD and AD, respectively. The intelligent quotient was significantly higher in the AD than in the CD. The most common comorbidity was depression in the CD and personality disorder in the AD. The most common reason for visiting the hospital was referral by acquaintances in the CD and media coverage in the AD. CONCLUSION: Clinicians should put ADHD on the index of suspicion when they examine adults with various psychiatric symptoms, because the diagnosis of ADHD might have been missed in childhood and the symptoms of ADHD might have changed as they grew up.

Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Short Term Result of Pubovaginal Sling Procedure Using Polypropylene Mesh for Female Stress Urinary Incontinence: Success Rate, Satisfaction, Risk Factors

PURPOSE: Sling procedures have been used successfully for the treatment of all type of female stress urinary incontinence. Polypropylene mesh has more biocompatibility with less erosion rate over other synthetic sling materials. We investigated the objective, subjective success rate, satisfaction on pubovaginal sling operation using polypropylene mesh in stress urinary incontinence women. MATERIALS AND METHODS: Between November 2001 and July 2002, thirty three women with stress urinary incontinence underwent polypropylene mesh sling procedure were analyzed. Preoperative evaluations included the patient's history, a physical examination, urinalysis, a urodynamic test, incontinence staging with Stamey grade, Balivas type, and so forth. A 1.5x20cm polypropylene mesh was placed under the bladder neck to proximal urethra. Postoperatively, the patients were evaluated with a symptom questionnaire, physical examination, uroflowmetry, and postvoid residual volume at 3 day, 3 months. RESULTS: The average follow-up period was 164.6 days (minimum; 2 months). The average operation time was 83.6 minutes (including the anesthesia). No major intra-operative, post-operative complication occurred. No patient has permanent retention, erosion, or repeated surgery. The 22 patients (66.7%) were completely continent, 11 (33.3%) had an improvement, subjectively. The 27 patients (81.8%) were completely continent, 6 (18.2%) had an improvement, objectively. The treatment result was showed satisfactory by all patients (very satisfaction; 20 (60.6%), satisfaction; 13 (30.4%)). The follow-up period, valsalva leak point pressure, Pdetmax, opened bladder neck at rest, preop. urgency, preop. and postop. urge incontinence, total score of preop. and postop. Urge syndrome were related to subjective success rate, satisfaction statistically (p<0.05). CONCLUSION: Placement of a polypropylene mesh under the bladder neck to proximal urethra provides a simple, safe, inexpensive and effective method to correct stress urinary incontinence.

Extracorporeal Shock Wave Lithotripsy for 57 Cases of Pediatric Urinary Stone with EDAP LT-01+ and Storz Modulith SLX Lithotriptors / 대한비뇨기과학회지

PURPOSE: Reports of clinical findings and treatment for pediatric urinary stone have been published relatively infrequently. Extracorporeal shock-wave lithotripsy (SWL) is a minimally invasive method of treating urinary stone and has been shown to be effective in the pediatric population. We evaluated the clinical characteristics of patients with pediatric urinary stone and compared the therapeutic results of two SWLs, LT-01+ and Modulith SLX lithotriptors. MATERIALS AND METHODS: The records of 57 children treated by SWL were analyzed retrospectively. Twenty-five patients were treated by LT-01+ (group I) and 32 by Modulith SLX (group II) lithotriptor. The outcomes, including the number of treatment sessions, stone free rate and complications, were assessed. RESULTS: The average age of all 57 children, 36 male and 21 female, was 14.3 years. Chief complaints were flank pain (71.9%), gross hematuria (10.5%) and urinary tract infection (12.3%). The average stone size was 8.2mm (2-15mm). The success rates of each SWL were similar in both groups (group I: 88.0%, group II: 90.6%). However the average number of treatment sessions/patient in Group I was significantly smaller than that of Group II (group I: 2.92, group II: 1.35, p<0.05). Flank pain and gross hematuria were developed similarly after treatment in both groups, and needed only conservative therapy and was resolved within three days. CONCLUSIONS: Clinical characteristics of urinary stone in children were similar to those of adults. There was no significant difference in treatment success rate between the two types of lithotriptors but the number of treatment sessions was smaller in patients treated by Modulith SLX lithotriptor.

Expression of Senescence-related Proteins in Rat Fracture Callus / 대한정형외과학회잡지

PURPOSE: To evaluate the expression of senescence-related proteins according to the aging process and to determine the role of senescence-related proteins in the bone tissue and their effects on the process of bone union. MATERIALS AND METHODS: 18 Sprague-Dawley rats (8 weeks old: 7, 32 weeks old: 6, and 70 weeks old: 5) were used in the experiment. A unilateral closed femur fracture was made, and the fracture callus was obtained 2 weeks after the fracture. The ossification process was observed in proliferative chondrocytes, the hypertrophic chondrocytes, and in the mesenchymal layer individually by immunohistochemistry, using p16, p21, c-fos and c-jun antibodies. RESULTS: There was no significant differences in the manifestation of p-16, p-21, c-fos, c-jun gene according to the age. The positive ratio of p-16 was maximal in proliferative chondrocytes (54.93%) and decreased in the mesenchymal layer (46.48%), and in hypertrophic chondrocytes (10.85%), in order. The positive ratio of c-fos was maximal in proliferative chondrocytes (73.32%) and decreased in the mesenchymal layer (51.84%), and in hypertrophic chondrocytes (9.64%), in order. CONCLUSION: We believe that senescent genes in the bone tissue participate in the differentiation of osteochondral cells and in the process of fracture callus ossification.

A Case of Scrotal Sparganosis Detected by Enzyme Linked Immunosorbent Assay (ELISA) / 대한비뇨기과학회지

Sparganosis usually means the plerocercoid larval infection of Spirometra species. It is endemic mainly in countries where the habit of eating raw snake or frog, or the habit of poulticing with snake skin exists. The most common endemic area is Korea, Japan and China, and the most common localizations are subcutaneous connective tissue and superficial muscles. We experienced a case of scrotal sparganosis in a 32-year-old man presenting with painless hard masses in left scrotum. He underwent by serum Enzyme Linked Immunosorbent Assay (ELISA) and was treated by surgical excision.