BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

Nontuberculous mycobacteria usually cause systemic disease and often appear as a primary pulmonary infection. However, a cutaneous lesion may be the first or only sign of infection. The most frequent human diseases caused by Mycobacterium fortuitum are cutaneous or soft tissue infections, usually preceded by injection, trauma or surgery. We report a case of a cutaneous lesion due to Mycobacterium(M.) fortuitum occuring in a 50-year-old man with a subcutaneous flat nodule on his left anterior tibia. He had received a small injury to his left shin in a swimming pool. The culture from the skin biopsy specimen on Lowenstein-Jensen medium yielded clolnies after 5 days. The microorganism was subsequently identified as M. fortuitum by selected biochemical reactions. Therapy was instituted with minocycline for 5 months.
Biopsy ; Humans ; Middle Aged ; Minocycline ; Mycobacterium fortuitum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Skin ; Soft Tissue Infections ; Swimming Pools ; Tibia

This study was designed to suggest community-based adolescent drug abuse program model to prevent, treat and rehabilitate the adolescent drug abusers, which works by cooperation between community hospitals and schools, by proving the effectiveness of community-based adolescent drug abuse problem for adolescent smoking students since smoking is one of the most common adolescent abuse problems in the community. To gain the basic data for proving the effect of community drug abuse program for adolescent smoking students, one male high school was selected as the studying school located in Seong Nam city. Among this high school students 146 students were selected randomly to investigate drug abuse status of this school. The experimental group was 33 students who participate in community-based drug abuse problem and the control group was 24 students who were selected randomly among the 60 smoking students who participated in investigating the drug abuse status in the studying school. The both experimental group and control group were reinvestigated of the drug abuse status eight months after completion of community-based drug abuse program, and change during this period was analysed with x2-test and t-test. The results and conclusions were as follows. 1) The smoking onset time was ranged mostly from senior in middle school to freshmen in high school and the most student smoked already habitually when they were freshmen in high school. 80% of smoking students had tried to quit smoking more th% one time and 20% had tried to quit smoking more than six times and failed. This data suggest that the smoking prevention program must be started as soon as possible far effectiveness of adolescent drug abuse program just before many students start smoking and the smoking cessation program for smoking students is needed desperately. 2) The the community-based drug abuse program for smoking students was effective. The smoking students who participate hi drug abuse program(experimental group) showed 19.2% decline of recent one month smoking rates eight months after completion of the program, but the smoking students who did not participate in drug abuse program(control group) showed 22.6% incline of recent one month smoking rates. In the experimental group, the Fagerstrom's nicotine dependance score and recent one month drinking rates showed no difference between initial and 8 month follow-up investigatement, but in the control group, the Fagerstrom's nicotine dependence scores were increased significantly from 1.80 to 3.43 and recent one month drinking rates showed 18.1% incline after 8 month 1311ow-up periods. 3) The smoking students who participate in drug abuse program has less school problems and increased family functioning and decreasing tendency of friends problems but less know ledge about cigarettes and more permissive in attitude to smoking after eight months follow-up period. These results suggest that students who participated in community-based drug abuse program experienced reduction of stress, which results in decline of smoking rates. Therefore, I think that the drug abuse program which deals with the psychological and emotional problems of adolescents is needed as much as direct education about the harmful effect of cigarettes in adolescent drug abuse program for smoking students.
Adolescent* ; Drinking ; Drug Users ; Education ; Follow-Up Studies ; Friends ; Gyeonggi-do ; Hospitals, Community ; Humans ; Male ; Nicotine ; Smoke* ; Smoking Cessation ; Smoking* ; Substance-Related Disorders* ; Tobacco Products ; Tobacco Use Disorder

OBJECTIVE: The authors study evaluated the effect of a cognitive rehabilitation program designed to enhance the attention skill of chronic schizophrenics. METHODS: Dependent variables included measures of perceptual sensitivity and response criterion derived from the Vigilance test of Vienna test system. Each of 10 subjects received 10 sessions of repeated training with computer-aided cognitive rehabilitation program(REHACOM). Eleven subjects were assigned to a control group. All subject were rated on measures of positive and negative symptoms before training. RESULTS: Significant changes on the outcome measures were observed following attention training. CONCLUSION: It is suggested that cognitive rehabilitation with chronic schizophrenics should stress the possibility of remediating deficiencies in basic abilities, such as attention.
Outcome Assessment (Health Care) ; Rehabilitation*

The purpose of this study is to compare the difference of the tendency for depression and leisure functioning between two elderly groups in differnt socio-cultural environment. Also, this study investigated whether the difference of lesiure functioning affected the tendency for depression. The participants are 55 elderly residing in the nursing home in Seoul and 35 Sahalin returning Koreans in KangWon-Do. Leisure Diagnostic Battery (LDB) developed by Witt and Eliss (1987) was used to measure leisure functioning of the elderly and Yesavage (1983)'s Geriatric Depression Scale (GDS measured the tendency of depression. The LDB and GDS were gathered through interviewing. The result of this study reports that the tendency of depreesion in Sahalin returning Koreans was higher than the elderly in Seoul. And the result supports the hypothesis that the elderly in Seoul who have maintained higher leisure functioning showed lower depression level than the Sahalin elderly who had poor leisure functioning. In other words, there were significance between these two groups. This study suggests that education and the leisure program shoud developed and applied for the higher leisure functioning and satisfaction of the elderly (especially elderly in nursing home).
Aged* ; Depression* ; Education ; Gangwon-do ; Humans ; Leisure Activities* ; Nursing ; Nursing Homes ; Seoul

OBJECTIVE: To evaluate the treatment efficacy and safety of risperidone and olanzapine in elderly dementia patients. METHODS: The study population consisted of 42 elderly patients in BPSD (Behavioral and Psychological Symptoms of Dementia) with dementia for 'risperidone' and 'olanzapine' treatment. Clinical safety and efficacy were evaluated by CGI (Clinical Global Impression) and the side effects checklist. RESULTS: The mean subject age was 68.2+/-5.9 consisting of 16 (38.1%) males and 26 (61.9%) females. The types of dementia among the 42 demented patients were as follows: 30 (71.5%) with Alzheimer's disease, 5 (11.9%) with vascular dementia, and 7 (16.7%) with unclassified dementia. The efficacy of risperidone and olanzapine was "marked improved 14.9% vs 34.0%", "moderately improved 45.2% vs 29.9%", and "mildly improved 30.3% vs 36.1%" by CGI. The incidence of adverse reaction was 25.8% vs 36.3%, respectively. CONCLUSION: Risperidone and olanzapine demonstrated highly useful and presented to be a well tolerated antipsychotic drug for behavioral and psychological symptoms of dementia between 1-2 mg vs 5-7.5 mg per daily dosage, respectively. However proper evaluation of mini-mental state examination, IADL (Instrumental Activities of Daily Living) and larger number of elderly patients must be analyzed.
Aged ; Alzheimer Disease ; Checklist ; Dementia* ; Dementia, Vascular ; Female ; Humans ; Incidence ; Male ; Risperidone ; Treatment Outcome

Tensor fascia lata myocutaneous flap is the most useful local flap in surgical treatment of greater trochanteric sore. But the small volume of muscle included in Tensor fascia lata myocutaneous flap makes the thickness of flap thinner and the rate of recurrence higher than any other muscle flap. To overcome this disadvantage, Scheflan(1981) used distal folded Tensor fascia lata myocutaneous flap in treating greater trochanteric sore. But Scheflan used this flap as an island flap, that made the blood supply unstable and unreliable, and required skillful technique. And he didn`t use distal part of the thigh which made the efficacy of flap bulk small. In order to thicken the flap bulk, we used the distal folded tensor fascia lata myocutaneous flap. We have treated 10 patients by using newly designed distal folded tensor fascia lata myocutaneous flap. All of them had previous systemic disease. Some had general paresthesia and others had heart failure, diabetic mellitus, neuralgia and so on. We drew V-shaped design, one wing was from the anterior superior iliac spine to the lateral condyle of the femur and the other wing was from the center of the greater trochanter to the lateral condyle of the femur. After design, we harvest the flap and fold the flap two or three times. Flap bulk is enough to prevent sore recurrence. We follow up the patients from 6 months to 35 months. No recurrence is occurred. Our newly designed flap has sufficient volume and reliable blood supply. The result is good and satisfactory.
Fascia Lata* ; Fascia* ; Femur* ; Follow-Up Studies ; Heart Failure ; Humans ; Myocutaneous Flap* ; Neuralgia ; Paresthesia ; Recurrence ; Spine ; Thigh

Tensor fascia lata myocutaneous flap is the most useful local flap in surgical treatment of greater trochanteric sore. But the small volume of muscle included in Tensor fascia lata myocutaneous flap makes the thickness of flap thinner and the rate of recurrence higher than any other muscle flap. To overcome this disadvantage, Scheflan(1981) used distal folded Tensor fascia lata myocutaneous flap in treating greater trochanteric sore. But Scheflan used this flap as an island flap, that made the blood supply unstable and unreliable, and required skillful technique. And he didn`t use distal part of the thigh which made the efficacy of flap bulk small. In order to thicken the flap bulk, we used the distal folded tensor fascia lata myocutaneous flap. We have treated 10 patients by using newly designed distal folded tensor fascia lata myocutaneous flap. All of them had previous systemic disease. Some had general paresthesia and others had heart failure, diabetic mellitus, neuralgia and so on. We drew V-shaped design, one wing was from the anterior superior iliac spine to the lateral condyle of the femur and the other wing was from the center of the greater trochanter to the lateral condyle of the femur. After design, we harvest the flap and fold the flap two or three times. Flap bulk is enough to prevent sore recurrence. We follow up the patients from 6 months to 35 months. No recurrence is occurred. Our newly designed flap has sufficient volume and reliable blood supply. The result is good and satisfactory.
Fascia Lata* ; Fascia* ; Femur* ; Follow-Up Studies ; Heart Failure ; Humans ; Myocutaneous Flap* ; Neuralgia ; Paresthesia ; Recurrence ; Spine ; Thigh

In the thyroid tissue, thyrotrophin(TSH) and IGF-I played major role of the goitrogen. But the evidences and precise mechanism of these two factors were not known so much. Actually local secretion of thyroid IGF-I was originated from its fibroblasts mainly. We guessed major roles of IGFs in the thyroid tissue were local paracrine effect of thyroid cells proliferation and differentiation which concert with TSH. Recently, some reporters described the source of thyroid IGF-I were partly from thyroid follicular cells and its action were synergistic with TSH. We measured TSH, IGF-I and IGFBP-3 from sera and thyroid cystic fluids in 36 patients with simple thyroid cyst and examined into correlation between TSH, IGF-I and IGFBP-3.1) According to cyst/serum TSH ratio, we classified two groups(Group I; c/s TSH <1, n=19. Group II; c/s TSH >1, n=17). This classification criteria means that cystic TSH level were increased than that of serum or not.2) The serum TSH, IGF-I and IGFBP-3 levels are not difference between group I and II.3) Cystic TSH were dependent on the serum TSH in Group I, but negative correlation in Group II. In Group II, cystic TSH was significant increased.4) Serum IGF-I were positive correlation in each Group5) In Group II, cystic IGF-I was not exceed than those of serum IGF-I, but some cystic IGFBP-3 were more increased than those of serum.6) In Group II, cystic IGFBP-3 increased than serum TSH, and cystic IGFBP-3 was positive correlation with cystic TSH and cystic IGF-I.As these data suggested that cystic TSH and cystic IGF-I levels may influence cystic IGFBP-3 level. The main effect for maintenance of cyst was mediated by cystic TSH and cystic IGFBP-3. But the cystic IGFBP-3 has major role for thyroid cyst than cyst TSH.
Classification ; Fibroblasts ; Humans ; Insulin ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Thyroid Gland

BACKGROUND: Depression is prevalent and a serious disorder in the elderly that interferes with social and physical function. It is associated with significant morbidity and a high mortality rate from suicide. Depression is highly treatable disease, but it remain largely unrecognized and untreated among the elderly. This study evaluate the factors related to depression of elderly, to be used as basic reference for management program in the community. METHODS: The cross-sectional study evaluates the depression of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, Geriatric Depression Scale (GDS), Mini-Nutritional Assessment (MNA), Mini-Mental Status Exam-Korean (MMSE-K), IADL, Social support network. T-test and multiple stepwise regression were constructed to explore the factors related to depression. RESULTS: Mean age was 71.22+/-7.1 with 101 male subjects and 200 female subjects. The mean GDS score was 6.9+/-3.7 and 56.5% of subjects were suggested depression (above 5 point on GDS). The mean score from the GDS showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, type of residency, cognitive function, presence of disease, number of medications, stress, subjective self perception of health, IADL, nutrition, emotional support, social activity support, instrumental support (p<0.05). In the multiple stepwise regression analysis on depression, nutrition, IADL, education, presence of disease were selected as highly correlated variables (p<0.05), and religion, cognitive function, subjective self perception of health, stress were also selected (p>0.05). These variables explained 34.2% of depression. CONCLUSION: Nutritional status, cognitive function, physical state, functional state, social support network demographic characteristics were related to depression in the elderly.
Aged* ; Cross-Sectional Studies ; Demography ; Depression* ; Education ; Female ; Health Expenditures ; Humans ; Internship and Residency ; Male ; Marital Status ; Mortality ; Nutritional Status ; Surveys and Questionnaires ; Rural Population* ; Self Concept ; Suicide