No abstract available.
Humans ; Spouses*

No abstract available.
Temporomandibular Joint Disorders*

OBJECTIVES: The purposes of this study were to evaluate the relationship between therapeutic compliance and emotional variables in the patients on maintenance hemodialysis and to make a help in planning the treatment in order to promote the therapeutic outcomes. METHODS: Subjects consisted of 43 end-stage renal disease patients who had been treated with hemodialysis for more than one year. Hostility was measured with Cook-Medly Hostility Scale and depressive symptom, with beck Depression Inventory(BDI) and anxiety, with Self-rating Anxiety Scale of Zung(SAS). Serum potassium(K), and phosphorus(P) level, and interdialytic weight gain(IWG) were selected as compliance indices, for they were said to reflect the effect of diet, medication and salts restriction, respectively. RESULTS: (1) While the patients on hemodialysis got the scores within the normal range in their anxiety and hostility scale, they showed higher score of BDI than normal person, which was wtatistically significant. (2) Considering the relationship between therapeutic compliance and emotional variables, diet compliance was significantly associated with the emotional variables such as depression and anxiety. The relationship would be drawn with the equation listed below; Compliance Value=4.656 x (Depression) + 2.592 x (Anxiety)-0.13 x (Depression)x(Anxiety)-9.742 (3) When the patients were given a series of supportive psychotherapy for about 1 month, they showed the decrease in the scores of anxiety and depression scales, and the elevation in compliance value. However, there was no room for saving that the compliance ratio was improved, because of the limitation in the research methodology. CONCLUSION: Therapeutic compliance depended on between depression and anxiety among the emotional variables, the supportive psychotherapy was useful method to improved the therapeutic compliance.
Anxiety ; Compliance* ; Depression ; Diet ; Hostility ; Humans ; Kidney Failure, Chronic ; Psychotherapy ; Reference Values ; Renal Dialysis* ; Research Design ; Salts ; Weights and Measures

BACKGROUND: To compare flexible ring with rigid ring for annular remodeling and hemodynamic changes of left ventricle (LV) in mitral valve repair (MVR) at short term interval. METHODS: From January 1998 to March 2001, 35 patients with mitral valve prolapse underwent mitral valve repair with ring annuloplasty. The mean age of these patients was 49 years. Eighteen patients underwent mitral annuloplasty with Carpentier-Edwards Classic-ring (Group A). Seventeen patients underwent mitral annuloplasty with Physio-ring (Group B). LV fun-ction and annulus size were assessed by echocardiography on the day before operation and 2 to 3 months later. Mitral annular motion had been examined by means of the extent of mitral annular systolic excursion (MASE) as measured in two longitudinal LV segments (septal and lateral). RESULTS: 1) In valve pathology, anterior leaflet lesion was 14 cases, posterior was 14, combined lesion was 7 cases. 2) At all, left ventricular end-systolic dimension, left ventricular end-diastolic dimension and LV mass decreased postoperatively. But, no differences existed between the groups. 3) Postoperatively (after 2-3 months), echocardiograms in 35 patients demonstrated no mitral regurgitation (MR) in 16 cases, trace to mild MR in 17 cases, moderate MR in 2 patients. In Classic-ring group, MR was demostrated in 11 cases (61%). In Physio-group, MR was demonstrated in 8 cases (47%). 4) Postoperatively, mitral valve area increased significantly only in patients with Physio-ring (1.93+/-0.33 vs 2.38+/-0.92, p<0.05). 5) No differences existed between the groups in MASE. CONCLUSION: There are the significant reduc-tion in cardiac chambers and annulus size and improvement of LV function after both types of ring annuloplasty at short term result. There are no significant differences between Classic-ring and Physio-ring except 2 cases postrepair SAM (systolic anterior motion) of mitral valve in Classic-ring.
Echocardiography ; Follow-Up Studies* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pathology

We report a case of esthesioneuroblastoma with intracranial extension treated with surgical resection and chemotherapy. A 5-year-old child presented with visual disturbance, and was subsequently found to have a huge sized mass in the anterior skull base, suprasellar region and lateral ventricle. A bifrontal craniotomy with excision of the tumor through subfrontal and interhemispheric approach was performed. The patient received postoperative chemotherapy according to Tandem protocol. A follow-up magnetic resonance(MR) image showed that the tumor showed partial regression, however, there was no change in tumor size in lateral ventricle. Second operation with excision of remnant mass through a transcallosal approach was performed. MR image, 9 months after first operation showed the postoperative change in frontal area without enhancing mass. By employing staged operation and chemotherapy, the authors obtained good results in the treatment of esthesioneuroblastoma with intracranial extension.
Child ; Child, Preschool ; Craniotomy ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Follow-Up Studies ; Humans ; Lateral Ventricles ; Skull Base

OBJECTIVES: Depression is a common affective problem in patients with chronic medical illness. It has been well known that depression gives negative influence to medical outcome in patients with chronic renal failure (CRF). The purpose of this study is to reveal the effects of antidepressant treatment on depressive symptoms and nutritional indexes. We hope that this study could be a help to make a new model in the treatment of patients with CRF. METHODS: For this study, 30 depressive patients with CRF on maintenance hemodialysis were included. As affective variables, Hamilton Depression Rating Scale (HDS) and Zung's Self-Rating Depression Scale (SDS) were used. Medical outcomes were assessed with the following nutritional parameters: Kt/V, normalized protein catabolic rate (nPCR), serum albumin concentration, BUN, intracelluar fluid(ICF), extracellular fluid (ECF), lean body mass, fat mass, percent body fat, waisthip ratio (WHR), and body mass index(BMI). Paroxetine, one of the SSRI classes, was administered as antidepressant for 8 weeks. For statistical analysis paired t-test was used for each variables. RESULTS: The prevalences of depression were 75% from HDS and 80% from SDS (N=40). The mean+/-SD of HDS and SDS score were 12.35+/-7.45 and 59.43+/-11.89 respectively. HDS score significantly decreased (p< 05) after antidepressant treatment for 8 weeks. There was a significant increase (<.05) in such nutritional parameters as nPCR, serum albumin concentration, BUN, ICF, ECF, and WHR. CONCLUSION: Both nutritional indexes and depressive symptoms improved after 8 weeks of antidepressant treatment. We suggest that improvement of depressive symptoms should contribute to improved nutritional indexes. Long-term follow up and placebo-controlled double blind study are firmly required to confirm the results of this study.
Adipose Tissue ; Depression* ; Double-Blind Method ; Extracellular Fluid ; Follow-Up Studies ; Hope ; Humans ; Kidney Failure, Chronic ; Nutrition Assessment* ; Paroxetine ; Prevalence ; Renal Dialysis* ; Serum Albumin

OBJECT: Currently, the alteration of cytokine system has been known to play an important role in regard to depressive symptom. We focused on the relationship between immunological parameters and clinical improvement in major depressive disorder. METHOD: Data were collected on 26 patients with major depressive disorder using a 8-week prospective follow-up design. After 8-week treatment period with fluoxetine, patients were classified into a response group and a non-response group according to their psychopathological outcome as evaluated by Hamilton Depression Rating Scale. The differences of the immunological parameters between pre-treatment phase and post-treatment phase were compared among patients. The difference of those was also compared within each phase among them. The relationship between socio-demographic variables, depression, cytokine, mononuclear cells was examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of clinical improvement of major depressive disorder. RESULT: Pre-treatment levels of IL-1beta in the response group were significantly higher than those in the non-response group. Pre-treatment levels of IL-1beta of all patients and in the response group were positively correlated with pre-treatment monocyte counts. Patients with subsequent remission showed significantly lower IL-6 values at baseline than those with non-response. Post-treatment values of IL-6 did not differ significantly among the patients. The correlation test showed more frequent relations among cytokines and mononuclear cells in the response group than in the non-responder group. Especially, serum level of IL-6 in pre-treatment phase was only significantly correlated with HAMD score after 8-week treatement phase, while other cytokines and mononuclear cells were not. Pretreatment level of IL-6 was of paramount importance in predicting clinical improvement of depressive symptom. CONCLUSION: The immune system of major depressive disorder patients might dichotomize the patients into subsequent responders and non-responders. Immune system might be of great influence on the clinical improvement of major depressive disorder. The mode of interaction between depression and cellular immune function and the mediators responsible for the cytokine production need to be studied further.
Cytokines ; Depression ; Depressive Disorder, Major* ; Fluoxetine ; Follow-Up Studies ; Humans ; Immune System ; Interleukin-6 ; Lymphocytes ; Monocytes ; Prospective Studies ; Tumor Necrosis Factor-alpha

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with the oral anticoagulant warfarin and can cause a serious bleeding complication. In this study, we evaluated the risk factors for international normalized ratio (INR) increase, which is a surrogate marker of bleeding, after addition of an NSAID in a total of 98 patients who used warfarin. Patient age, sex, body mass index, maintenance warfarin dose, baseline INR, coadministered medications, underlying diseases, and liver and kidney functions were evaluated for possible risk factors with INR increase > or =15.0% as the primary end-point. Of the 98 patients, 39 (39.8%) showed an INR elevation of > or =15.0% after adding a NSAID to warfarin therapy. Multivariate analysis showed that high maintenance dose (>40 mg/week) of warfarin (P=0.001), the presence of coadministered medications (P=0.024), the use of meloxicam (P=0.025) and low baseline INR value (P=0.03) were the risk factors for INR increase in respect to NSAID-warfarin interaction. In conclusion, special caution is required when an NSAID is administered to warfarin users if patients are taking warfarin >40 mg/week and other medications interacting with warfarin.
Adult ; Aged ; *Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; *Anticoagulants/adverse effects/therapeutic use ; Drug Interactions ; Female ; Hemorrhage/*chemically induced ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thiazines/adverse effects/therapeutic use ; Thiazoles/adverse effects/therapeutic use ; *Warfarin/adverse effects/therapeutic use

BACKGROUND: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. MATERIAL AND METHOD: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). RESULT: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). CONCLUSION: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.
Atrial Fibrillation* ; Echocardiography ; Follow-Up Studies ; Heart Atria* ; Heart Valve Diseases ; Humans ; Pulmonary Veins ; Veins

Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.
Abscess ; Blood Sedimentation ; Drainage ; Female ; Graves Disease ; Humans ; Hypothyroidism ; Neck Pain ; Prednisolone ; Respiratory Tract Infections ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Subacute* ; Young Adult