BACKGROUND: Headache is a common complaint in patients presenting to the emergency department(ED). Many patients suffered sustained headache even after presenting to the ED. This study investigate whether the patients were received analgesics and timely adequate. METHOD: We analyzed 131 adolescent and adult patients with non-traumatic headache without any neurologic deficit in two emergency department during 6 months period retrospectively. RESULTS: The positive and negative predictive value according to primary impression were 47% and 74% respectively. The mean time to take brain computed tomography(CT) after ED presentation was 120 minutes. The patients with primary impression of intracranial hemorrhage(mainly SAH) were the most fast(mean time 88+/- 70 minutes). 28(21%) patients were received analgesics before taking brain CT(after ED presentation), and 70(53%) patients after CT, 27(54%) patients after cerebrospinal fluid examination. The mean time interval were 43, 126 and 149 minutes on each group being received the analgesics. CONCLUSION: According to this study many patients suffered sustained headache before being classified to certain type of disorder. It may due to the reasons that there were no definite guidelines treating headache, the pain itself, or the physician treats patients as physician's way.
Adolescent ; Adult ; Analgesics ; Brain ; Cerebrospinal Fluid ; Emergencies* ; Emergency Service, Hospital* ; Headache* ; Humans ; Neurologic Manifestations ; Retrospective Studies

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.
Coma ; Emergency Service, Hospital ; Humans ; Retrospective Studies

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.
Anesthesia ; Animals ; Asphyxia* ; Brain ; Carotid Arteries ; Electrocardiography ; Electrodes ; Epinephrine* ; Femoral Vein ; Halothane ; Humans ; Male ; Myocardium ; Nitrous Oxide ; Rats* ; Rats, Sprague-Dawley ; Resuscitation* ; Survival Rate ; Vasopressins*

Objective: The risk of rapid cognitive decline in Alzheimer’s disease (AD) during the coronavirus disease 2019 (COVID-19) pandemic has been recognized. The purpose of this study was to investigate the cognitive decline in such patients during the COVID-19 pandemic by evaluating changes in their cognitive measure parameters before and after the pandemic. Methods: This was a retrospective cohort study conducted in AD patients during their first visit and one-year regular follow-up for testing cognitive function at the Geriatric Psychiatry Clinic of Seoul St. Mary’s Hospital. Changes in the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Sum of Box for CDR (CDR-SB) scores were investigated. A time series analysis was performed to determine whether there was a significant difference in the MMSE, CDR, and CDR-SB scores of AD patients in pre- and post–COVID-19 periods. Results: Overall, 130 AD patients aged 60 to 93 years were assessed. Their baseline mean MMSE score was 22.30 which had decreased to 21.08 at the one-year follow-up. Before November 2019, the average CDR differences for one year was 0.06, but after November 2019, it increased to 0.36 (p<0.001). Before November 2019, the average of the CDR-SB change value for one year was 1.69, but after November 2019, it increased to 3.00 (p<0.001). The difference in MMSE values for one year was not statistically significant. The time series analysis revealed a significant increase in the CDR and CDR-SB scores by approximately 0.47 (p=0.005) and 2.39 (p=0.002), before and after November 1, 2019, respectively. Conclusion This study revealed that the COVID-19 pandemic and social distancing worsen cognitive function in AD patients rapidly. Exposure to the COVID-19 pandemic and social distancing for at least seven months worsen cognitive decline significantly. Therefore, in order to minimize the adverse effects of the cognitive decline in these patients, the period of social distancing should be minimized.

OBJECTIVE: Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). METHODS: Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT. RESULTS: Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation. CONCLUSION: Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.
Anxiety ; Depression ; Diagnosis ; Education ; Hospitalization ; Humans ; Inpatients ; Mass Screening* ; Seoul ; Thermometers

OBJECTIVE: No reports have investigated the influence of age at first or last childbirth on maternal mental health. The aim of this study was to determine whether there is an association between age at first or last childbirth and the mental health of premenopausal women. METHODS: The data used in this study were collected from the 2010 to 2012 Korea National Health and Nutrition Examination Surveys. A total of 3,370 premenopausal women were considered. The association between childbirth age and maternal mental health factors, including stress, depressed mood, and suicidal ideations were analyzed using multiple logistic regression analyses adjusted for confounding factors. RESULTS: After adjusting confounding factors, younger maternal age at first childbirth was found to be associated with an increase in the prevalence of maternal depressed mood and suicidal ideations. Also, older maternal age at last childbirth was related to an increase in maternal stress, depressed mood and suicidal ideations. CONCLUSION: Both younger first childbirth and older last childbirth maternal age may be risk factors for poor outcomes of premenopausal women’s mental health. These data support the need for comprehensive mental health assessment for premenopausal women who either gave birth at an age too young or too old.
Depression ; Female ; Humans ; Korea ; Logistic Models ; Maternal Age ; Mental Health ; Nutrition Surveys ; Parturition ; Prevalence ; Risk Factors ; Suicidal Ideation ; Suicide

OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.
Aged ; Boston ; Brain ; Depression ; Executive Function ; Humans ; Magnetic Resonance Imaging ; Stroop Test ; Trail Making Test ; Treatment Outcome

BACKGROUND: The primary mediastinal lymphoma (PML) is defined as the non-Hodgkin's lymphoma that presents primarily within the mediastinum, and primary mediastinal diffuse large B cell lymphoma (PMLBL) is defined as primary mediastinal lymphoma of which histology shows diffuse large B cell lymphoma. There is no available clinical study yet about the clinical characteristics and treatment outcome of PMLBL in Korea. Here the authors report our experience of 21 cases of PML including 11 cases of PMLBL. METHODS: The authors reviewed retrospectively medical records of 21 cases with PML from January 1992 to January 2003, and analyzed clinical characteristics, response to induction therapy, and survival. The authors subsequently performed subset analysis in 11 cases with PMLBL. Median follow-up period was 16 months (range, 4~80 months). RESULTS: Male to female ratio was 8:13 and the median age of 21 PML cases was 33.5 years. Of 21 PML cases, histology of most cases was diffuse large B cell lymphoma (11/21) and lymphoblastic lymphoma (8/21). Cell lineage was B cell in 13 cases (61.9%). Thirteen cases (62.0%) were in stage I and II. Initial induction therapy was chemotherapy alone in 19 cases, combined chemoradiotherapy in 1 case and no treatment in remaining 1 case. Response rate to initial therapy was 70% in 20 PML cases (complete response [CR] 50%, partial response 20%) with CR of 50% in 10 PMLBL. Median progression-free survival and overall survival for 11 PMLBL cases were 11 months and 16 months, respectively. CONCLUSION: Incidence of PML showed slight predominance in female and in relatively young age with median age of less than 40 years. Most patients presented with a chief complaint of superior vena cava syndrome including dyspnea. The most common histology of PML was diffuse large B cell lymphoma. PMLBL represented low complete response rate to conventional chemotherapy, low progression-free and overall survival rates compared with peripheral diffuse large B cell lymphoma by historical review.
Cell Lineage ; Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Mediastinum ; Medical Records ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Superior Vena Cava Syndrome ; Survival Rate ; Treatment Outcome*

Amiodarone is an antiarrhythmic drug known to have adverse effects on multiple organs. Most studies have reported the side effects of the drug, which may result from rapid administrations or from long-term, high dosage administrations. However, toxicity issues have also been reported from patients administered with low doses of the drug for a long period of time. Here we report a case of an 82-year-old female who had shown symptoms and signs of pulmonary, hepatic, and neurotoxicity after taking amiodarone for 14 months in order to treat her atrial fibrillation without regular outpatient follow-up. We highlight the importance of the recommended evaluations, including lung, liver, and thyroid functions, as well as the neurological examinations in patients treated with amiodarone for a long period of time during regular follow-up.
Aged, 80 and over ; Amiodarone* ; Atrial Fibrillation* ; Cardiomyopathy, Hypertrophic* ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neurologic Examination ; Outpatients ; Thyroid Gland

BACKGROUND/AIMS: Cyclooxygenase (COX)-2 levels are elevated in several types of human cancer tissues. COX-2 is not constitutively expressed by most normal tissues, but it is rapidly induced by certain inflammatory cytokines, tumor promoters, growth factors and oncogenes. Inflammation is important risk factor for intrahepatic cholangiocarcinoma. Therefore, this study was aimed to evaluate the role of COX-2 in intrahepatic cholangiocarcinoma development. METHODS: 18 intrahepatic cholangiocarcinoma patients was conducted in this study. COX-2 expression was investigated by immunohistochemical staining in resected liver specimen that involved 47 hyperplasia, 30 low-grade dysplasia, 38 high- grade dysplasia and 18 cancer. The relationship of clinicopathological factor and COX-2 expression of cancer was evaluated. RESULTS: COX-2 expression was not observed in normal bile duct epithelium. COX-2 expression in high-gade dysplasia was higher than in low-grade dysplasia. COX-2 expression in cancer was higher than in hyperplasia, low-grade and high grade dysplasia. There was no significant correlation between clinicopathological factors and COX-2 expression in cancer. CONCLUSION: These findings suggest that COX-2 may play a role in the early and late carcinogensis of intrahepatic cholangiocarcinoma.
Bile Ducts ; Carcinogenesis ; Carcinogens ; Cholangiocarcinoma* ; Cyclooxygenase 2* ; Cytokines ; Epithelium ; Humans ; Hyperplasia ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Liver ; Oncogenes ; Prostaglandin-Endoperoxide Synthases ; Risk Factors