OBJECTIVES: Chronic alcohol consumption has been known to result in various neurocognitive deficits. Many neuropsychological studies revealed that the major disturbances occurred in the executive function learning and short-term memory. visuospatial performance function, perceptuo-motor skills and abstraction and problem solving abilities. This study was done to identify which cognitive areas might be mainly affected. METHODS: The cognitive disturbance was evaluated using the Korean Version of the Mini Mental State Examination(MMSEK) and the 7 Minute Screen(7MS) in male inpatients with alcohol dependence(N=31) as well as in age and education level matched healthy male controls(N=30) Four individual tests of the 7MS were consisted of the Benton Temporal Orientation Test the Enhanced Cued Recall, the Clock Drawing and the Category Fluency. RESULTS: 1) The average scores of four individual test of the 7MS for the alcoholics were 2.77+/-4.38 for the Benton Temporal Orientation Test. 13.90+/-2.02 for the Memory Test(the Cued Recall 6.77+/-1.94, the Uncued Recall 7.10+/-2.45), 5.84+/-1.86 for the Clock Drawing and 12.58+/-3.29 for the Category Fluency. Except the Benton Temporal Orientation Test, there were statistically significant differences between test scores of alcoholics and those of controls(p<0.01). 2) The alcoholics who had MMSE-K score<24 were 9.68%. The average(+/-S.D) score of the MMSE-K for the patient group(27.23+/-2.62) was significantly(p<0.001) lower than that of the healthy controls(29.20+/-1.24) There were no statistically significant differences between four individual test scores of the 7MS of alcoholics with the MMSE-K score<24(N=3) and those of alcoholics with the MMSE-K score > or =24(N=28) 3) Four individual test scores of the 7MS seemed to have statistically significant association with such variables as MMSE-K, duration of alcohol drinking blood magnesium concentration liver function and thyroid function. CONCLUSION: Mild deficits of cognitive areas such as orientation, memory, visuospatial abilities and verbal fluency could be found in alcohol dependence.
Alcohol Drinking ; Alcoholics* ; Alcoholism ; Education ; Executive Function ; Humans ; Inpatients ; Learning ; Liver ; Magnesium ; Male ; Mass Screening* ; Memory ; Memory, Short-Term ; Problem Solving ; Thyroid Gland

OBJECTIVES: 'The 7 Minute Screen' was reported so sensitive to discriminate mild dementia. The test results were not influenced by the education, age and sex. Furthermore, the examiners needed no professional training. The tests covered the cognitive areas such as memory, oritention to time, verbal fluency and visuospatial or visuoconstructional abilities. The aims of this study were to evaluate the efficiency of 'The 7 Minute Screen' to discriminate differences between illnesses, and to analyze the factors affecting the test results. METHODS: 'The 7 Minute Screen' and the Mini-Mental State Examination (MMSE) were obtained from 36 inpatients with dementia of the Alzheimer's type (N=8), vascular dementia (N=8), Major depressive disorders (N=10) and alcohol dependence (N=10). The test battery was consisted of the Benton Temporal Orientation, the Enhanced Cued Recall, the Clock Drawing and the Category Fluency. RESULTS: 1) On the Benton Temporal Orientation, the highest mean scores were obtained in vascular dementia. On the memory, the lowest mean scores were obtained in vascular dementia, especially on the Uncued Recall in the dementia of the Alzheimer's type, and on the Cued Recall in vascular dementia. On the Clock Drawing, the lowest mean scores were obtained in the dementia of the Alzheimer's type. On the Category Fluency, the lowest mean scores were obtained in the dementia of the Alzheimer's type. 2) There was no statistically significant difference between 4 illness groups on the Benton Temporal Orientation. While there were no differences between 4 illness groups on total scores of memory and the Cued Recall, on the Uncued Recall showed significant difference between alcohol dependence and other illness groups (p<0.05). On the Clock Drawing, there was no significant difference between 4 illness groups. On the Category Fluency, there was significant difference between alcohol dependence and dementia of the Alzheimer's type and vascular dementia (p<0.001), and major depressive disorders (p<0.01). 3) In the dementia of the Alzheimer's type, the test scores of the Clocking Drawing were correlated positively with the education level (gamma=0.740, p<0.05), and negatively on the sex (gamma=-0.902, p<0.005), while in major depressive disorders, there was negative correlation between the Cued Recall and the age (gamma=-0.725, p<0.05). Otherwise, there were no significant correlation between the scores of individual tests with age, sex and educational level in vascular dementia and alcohol dependence. CONCLUSIONS: 'The 7 Minute Screen' seemed to be more superior to find out mild cognitive deficit than the Mini-Mental State Examination as well as it might be useful to discriminate differences between illnesses. However, some individual test results of a kind of illnesses could be influenced by the education level, age and sex.
Alcoholism* ; Dementia* ; Dementia, Vascular ; Depressive Disorder, Major* ; Education ; Humans ; Inpatients ; Mass Screening* ; Memory

Between 1987 and 1992, 86 tibial fractures were treated with the Ilizarov external fixator at Gyeong-Sang National University Hospital and Okpo Hospital. The mean follow-up period was 31.4 months. Sixty-six were open fractures and twenty were closed fractures with severe comminution. In 66 open fractures, there were 9 Gustilo type I, 10 type II, and 47 type III fractures. Of 66 open fractures, 22 had bone defects ranged from 2cm to 17cm and 16 had extensive loss of soft tissue. Twenty-two bone defects were treated with cancellous bone grafts in 8 cases, bifocal osteosynthesis with bone graft in 12 cases, and trifocal osteosynthesis with bone graft in 2 cases. Thirty-four extensive soft tissue defects were treated with split-thickness skin graft, musculocutaneous flap, soft tissue transportation with ring used in bifocal, trifocal osteosynthesis, and acute shortening of fracture site. Of 20 closed fractures, 14 were treated with cancellous bone graft for decreasing union time and 6 were treated with monofocal compression without bone graft. The mean time to union was 20.5 weeks in closed fractures, and 35.4 weeks in open fractures. Of 40 complications, 12 were knee and ankle joint contractures, 12 were soft tissue and bone infections of pin tract, 5 were refracture, 5 were angular deformities of 10 degree or more, 5 were delayed union, and 2 were nonunion. According to Tucker's classification, the results were graded as excellent in 31, good in 38, fair in 12, and poor in 5 cases. Primary or secondary bone graft is necessary for early bony union and anatomical reduction combined with bone graft could prevent the complications of delayed union and nonunion.
Ankle Joint ; Classification ; Congenital Abnormalities ; Contracture ; External Fixators ; Follow-Up Studies ; Fractures, Closed ; Fractures, Open ; Ilizarov Technique ; Knee ; Myocutaneous Flap ; Skin ; Tibia ; Tibial Fractures ; Transplants ; Transportation

Anastomoses between a coronary artery and bronchial or mediastinal arteries have been described since the 19th century. Although coronary-to-bronchial artery communication has been well described, it remains an unusual finding. We report one adult case of abnormally enlarged two coronary-to-bronchial artery communications in a severe cystic bronchiectasis patient. In this case, the bronchial arteries were also supplied from the multiple systemic arteries (the internal mammary, subclavian, inferior phrenic and intercostal arteries) because of severe cystic bronchiectasis. We treated the patient by embolization of the bronchial artery with the abnormal anastomoses and then by surgical resection of the cystic bronchiectatic lung lesion. To date, the patient remains free of symptoms.
Adult ; Arteries* ; Bronchial Arteries ; Bronchiectasis* ; Coronary Vessels ; Humans ; Lung

BACKGROUND: Because of widespread and long-term use of lead, many lead poisoning cases were reported. Especially, in Korea including Southeast Asia, we observed non-occupational lead poisoning cases by herbal medication. METHODS: We identified total 45 cases of lead poisoning through Medric search, from 1973 to 2002. Bibliographies of relevant articles were reviewed. We arranged cases by attributes following 1) reported year, 2) age, 3) sex, 4) exposure sources, 5) exposure duration, 6) clinical manifestation, 7) treatments. RESULTS: The average age of the patients was 41.4 +/- 15.7 year-old. The distribution by sex did not have difference each other. The non-occupational lead poisoning cases were mostly caused by Chinese herbal medication. On the cases of the herbal lead poisoning, average exposure duration was 7.3 +/- 3.8 months and the various dosages were taken from 5 mg to 3 g. The major clinical symptoms were abdominal pain, headache, and constipation. The typical laboratory finding was anemia. Major treatment agent was oral penicillamine. CONCLUSION: To differential diagnose of the lead poisoning from many diseases with similar symptoms is very difficult solely on the clinical aspect. Especially, in non-occupational cases it is more difficult. In Korea, non-occupational lead poisoning cases by herbal medication have been discovered more than in western countries. We reviewed about the lead poisoning cases since 1973, so we want to make an aware of scientific and rational making and management of lead in the health supplementary food and herbal medicine.
Abdominal Pain ; Anemia ; Asia, Southeastern ; Asian Continental Ancestry Group ; Constipation ; Headache ; Herbal Medicine ; Humans ; Korea* ; Lead Poisoning* ; Penicillamine

BACKGROUND AND OBJECTIVES: Smoking has been known to be an independent risk factor of the coronary morbidity induced by coronary artery endothelial dysfunction, but its detailed impact, including the duration and amount of smoking on coronary artery spasm, has not been clarified yet. We investigated the incidence of acetylcholine (Ach)-induced coronary artery spasm according to smoking and the smoking-related parameters. SUBJECTS AND METHODS: The study consisted of 306 patients (163 males, age: 56.1+/-11.2 years), without significant coronary artery disease underwent Ach provocation testing by injecting incremental doses of 20, 50 and 100 ug Ach into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>75%) with/without chest pain or ST-T change of the EKG. The impact of conventional risk factors, including smoking and the smoking-related parameters, on coronary artery spasm was analyzed. RESULTS: The conventional risk factors of coronary atherosclerosis, including hypertension, DM and hyperlipidemia, were numerically higher in the provocation (+) group, but the differences were not statistically different between the two groups. Only smoking itself was significantly higher in the provocation (+) group whereas the smoking duration, amount and the duration of quitting smoking were not different between the two groups. CONCLUSION: Smoking is known to be an independent risk factor of coronary artery spasm, but smoking-related parameters such as the smoking duration, the amount and the duration of quitting smoking were not associated with coronary artery spasm.
Acetylcholine ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels* ; Electrocardiography ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Male ; Phenobarbital ; Risk Factors ; Smoke* ; Smoking* ; Spasm*

The prevalence of Clonorchis sinensis metacercariae (CsMc) was examined in freshwater fish from the water systems of Seomjin-gang (River), the Republic of Korea. Total 1,604 fish from 7 local sites of Seomjin-gang were examined by artificial digestion methods. The metacercariae of C. sinensis were detected in 102 (39.8%) out of 256 fish (14 species) from the upper reaches of Seomjin-gang, i.e., Osucheon (22.3% in 6 fish species) in Imsil-gun, and Seomjin-gang (63.9% in 9 fish species) in Sunchang-gun, Jeollabuk-do. Their average density was 9.0 per infected fish. They were also found in 132 (48.0%) out of 275 fish (12 spp.) from the middle reaches of Seomjin-gang, i.e., Songdaecheon (58.9% in 4 fish species) in Namwon-si, Jeollabuk-do, and Seomjin-gang (45.2% in 10 fish species) in Gokseong-gun, Jeollanam-do. Their average density was 21.0 per infected fish. CsMc were detected in 77 (56.6%) out of 136 fish (11 species) from the lower reaches of Seomjin-gang, i.e., Seomjin-gang (73.3% in 11 fish species) in Gurye-gun, Jeollanam-do, and Namsancheon (8.6% in 1 fish species) in Hadong-gun, Gyeongsangnam-do. Their average density was 64.9 per infected fish. The metacercariae of Metorchis orientalis were also detected in 6 fish species from 4 sites of Seomjin-gang. Conclusively, it has been confirmed that CsMc are more or less prevalent in fish from some water systems of Seomjin-gang in Korea.
Clonorchis sinensis* ; Digestion ; Fresh Water ; Gyeongsangnam-do ; Jeollabuk-do ; Jeollanam-do ; Korea ; Metacercariae* ; Prevalence* ; Republic of Korea ; Water*

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.
Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*complications ; Choledocholithiasis ; Common Bile Duct Diseases/*etiology ; Female ; Humans ; Rupture, Spontaneous

Mitochondrial myopathies are diseases caused by defects in metabolic pathway of mitochondria. Mitochondrial myopathy is known as one of the causes of recurrent myoglobinuria, while clinically, rarely causes acute renal failure requiring medical treatments. We report a case of rhabdomyolysis and acute renal failure associated with mitochondrial myopathy. A 58-year-old male was presented with dyspnea and hypotensive shock. The patient had a history of recurrent dark colored urine and cramping leg pain after prolonged fasting. Laboratory findings showed hyperkalemia, azotemia, metabolic acidosis, and elevated AST, ALT, and creatinine kinase. He had no history of trauma or medication. Muscle biopsy showed "ragged red fibers" in modified Gomori staining. On electron microscope, increased number of mitochondria and abnormal mitochondria were seen. He received hemodialysis and his renal function recovered after 1 month.
Acidosis ; Acute Kidney Injury* ; Azotemia ; Biopsy ; Creatinine ; Dyspnea ; Fasting ; Humans ; Hyperkalemia ; Leg ; Male ; Metabolic Networks and Pathways ; Middle Aged ; Mitochondria ; Mitochondrial Myopathies* ; Muscle Cramp ; Myoglobinuria ; Phosphotransferases ; Renal Dialysis ; Rhabdomyolysis* ; Shock

Scrub typhus develops after the individual is bitten by a trombiculid mite infected with Orientia tsutsugamushi. Since it has been reported that pneumonia is frequently observed in patients with scrub typhus, we investigated whether intranasal (i.n.) vaccination with the outer membrane protein of O. tsutsugamushi (OMPOT) would induce a protective immunity against O. tsutsugamushi infection. It was particular interest that when mice were infected with O. tsutsugamushi, the bacteria disseminated into the lungs, causing pneumonia. The i.n. vaccination with OMPOT induced IgG responses in serum and bronchoalveolar lavage (BAL) fluid. The anti-O. tsutsugamushi IgA Abs in BAL fluid after the vaccination showed a high correlation of the protection against O. tsutsugamushi. The vaccination induced strong Ag-specific Th1 and Th17 responses in the both spleen and lungs. In conclusion, the current study demonstrated that i.n. vaccination with OMPOT elicited protective immunity against scrub typhus in mouse with O. tsutsugamushi infection causing subsequent pneumonia.