Green tobacco sickness is an illness caused by dermal exposure to nicotine. The common symptoms of the disease include dizziness, headache, nausea, vomiting, severe general weakness, fluctuations of blood pressure or heartbeat, abdominal cramping, chills, increased sweating, salivation, and difficulty breathing. A 79-year-old female arrived at the emergency room for an evaluation of sudden onset dizziness. Magnetic resonance imaging and angiography of the brain did not show any relevant abnormal findings. Four days later, with supportive care, she said that she had harvested green tobacco for six hours on the day of admission and the tobacco harvest was the first time in her life. She sweated excessively during the hot and humid weather and the tobacco leaves were wet from rain the night before. The serum cotinine tested at five days of admission was 16ng/ml. She was diagnosed with acute nicotine poisoning by her clinical symptoms and the half-life of cotinine in the blood.

OBJECTIVES: Seoul-Activities of Daily Living(S-ADL) was developed to assess elderly person's basic activities of daily living. This study aims to develop standardized ADL assessment scale and confirm the reliability and validity of the S-ADL. METHODS: It was participated in 336 controls and 145 patients diagnosed Alzheimer's disease. RESULTS: In controls, it was statistically significant to age, but not sex, education, region and presence of spouse. Also, reliability and validity were statistically significant. Principal axis factoring analysis revealed three factors that accounted for 66.67% of the total variance(1.self-care/hygiene, 2.ambulation, 3.toileting). According to each CDR stage, there were significant difference, except for CDR 0.5 and CDR 1 suggesting early dementia. Particularly, it was remarkable for functional impairment in CDR 2 and CDR 3 suggesting moderate to severe dementia. The order of the loss of function was (1) self-care/hygiene, (2) toileting, and (3) ambulation. CONCLUSIONS: Our study showed that the S-ADL could be a very reliable and valid tool for the assessment of functional disabilities of Korean dementia patients. Particularly, S-ADL would be useful in assessing daily function of moderate to severe AD.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Axis, Cervical Vertebra ; Dementia ; Education ; Humans ; Reproducibility of Results* ; Spouses ; Walking

No abstract available.
Epilepsy ; Migraine Disorders ; Migraine with Aura*

The subacute necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a benign, self-limited disorder of unknown cause. This rare disease is characterized by fever, lymphadenopathy, leukopenia, and elevated sedimentation rate. This disease preferentially affects young women. The diagnosis of this disease is confirmed by involved lymphnodes biopsy. Evidence for autoimmune dysfunction has been reported, but is usually lacking. According to the review of the literatures, a total of 192 cases of subacute necrotizing lymphadenitis were reported in Korea since 1983 mostly in literatures of pathology or internal medicine and only 7 cases in pediatrics. There was female predominance in a 141:51 ratio. However, among 25 cases of under 20 years of age, there was male predominance in a 16:9 ratio. The patients of under and over 20 years of age were 29 and 82, respectively among the age-known 111 cases of 192 reported. We experienced a 13-year-old boy, who had right cervical lymphadenitis with persisting high temperature and pain on lymph nodes for more than 10 days. An excisional cervical lymph node biopsy was performed and pathologic diagnosis was compatible with subacute necrotizing lymphadenitis. Most antibiotics were not effective, but fever subsided with one day of oral prednisolone therapy. Various laboratory studies for prolonged fever were negative except leukopenia and increased sedimentation rates. The CD4/CD8 ratios in acute and recovery stages were 1.1 and 1.5 respectively, showing mild decrease of CD4/CD8 ratio in the acute stage. Decreased T cell proportions in the acute stage were also noted.
Adolescent ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Internal Medicine ; Korea ; Leukopenia ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Lymphocyte Subsets* ; Lymphocytes* ; Male ; Pathology ; Pediatrics ; Prednisolone ; Rare Diseases

The subacute necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a benign, self-limited disorder of unknown cause. This rare disease is characterized by fever, lymphadenopathy, leukopenia, and elevated sedimentation rate. This disease preferentially affects young women. The diagnosis of this disease is confirmed by involved lymphnodes biopsy. Evidence for autoimmune dysfunction has been reported, but is usually lacking. According to the review of the literatures, a total of 192 cases of subacute necrotizing lymphadenitis were reported in Korea since 1983 mostly in literatures of pathology or internal medicine and only 7 cases in pediatrics. There was female predominance in a 141:51 ratio. However, among 25 cases of under 20 years of age, there was male predominance in a 16:9 ratio. The patients of under and over 20 years of age were 29 and 82, respectively among the age-known 111 cases of 192 reported. We experienced a 13-year-old boy, who had right cervical lymphadenitis with persisting high temperature and pain on lymph nodes for more than 10 days. An excisional cervical lymph node biopsy was performed and pathologic diagnosis was compatible with subacute necrotizing lymphadenitis. Most antibiotics were not effective, but fever subsided with one day of oral prednisolone therapy. Various laboratory studies for prolonged fever were negative except leukopenia and increased sedimentation rates. The CD4/CD8 ratios in acute and recovery stages were 1.1 and 1.5 respectively, showing mild decrease of CD4/CD8 ratio in the acute stage. Decreased T cell proportions in the acute stage were also noted.
Adolescent ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Internal Medicine ; Korea ; Leukopenia ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Lymphocyte Subsets* ; Lymphocytes* ; Male ; Pathology ; Pediatrics ; Prednisolone ; Rare Diseases

OBJECTIVE: To investigate the sleep state of mild stroke patients and relationship between sleep disturbance and functional status. METHODS: A total of 80 acute stroke patients were enrolled in this study. The criteria for inclusion in the study was as following: 1) first stroke, 2) cognitive function preserved enough to perform the test (Mini Mental State Examination > or =24), 3) good functional levels (Modified Rankin Scale < or =3), 4) upper extremity motor function preserved enough to perform occupational tests (hand strength test, Purdue pegboard test, 9-hole peg test, and Medical Research Council score > or =3), and 5) less than 2 weeks between the stroke and the assessment. Quality of sleep was assessed by using Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Activities of daily living was assessed by using the Modified Barthel Index (MBI) and depressed mood was assessed by using the Beck Depression Inventory (BDI). Gross and fine motor function of the upper extremity was assessed by using hand strength test (Jamar dynamometer), Purdue pegboard test, and the 9-hole peg test. RESULTS: The results of the occupational assessment were fine in the good sleepers. The PSQI, ESS, and ISI were correlated with some of the assessment tools (BDI, MBI, Purdue pegboard, 9-hole peg, and hand strength). CONCLUSION: In conclusion, this study emphasizes that sleep disturbance can affect the functional status in mild acute stroke patients. Therefore, clinicians must consider sleep status in stroke patients and need to work to control it.
Activities of Daily Living ; Depression ; Hand ; Hand Strength ; Humans ; Sleep Initiation and Maintenance Disorders ; Stroke* ; Upper Extremity

OBJECTIVE: Serotonin transporter (5-HTT) is a key synaptic regulator of serotonergic neurotransmission and a major site of action of most antidepressants. The functional polymorphism of 5-HTT gene is reported to be associated with antidepressant responsiveness. Norepinephrine transporter (NET) and dopamine transporter (DAT) are also the targets for antidepressant drugs, and these biogenic amine transporters share a similar structure and mode of action as 5-HTT. We investigated the association between genetic polymorphisms of biogenic amine transporters and antidepressant response. METHODS: We genotyped 203 patients with major depressive disorder and 147 normal controls, using polymerase chain reaction (PCR) of genomic DNA with primers flanking the second intron and promoter regions of 5-HTT gene, and the 3' untranslated region of DAT. NET-1 (Thr99Ile) and NET-8 (1287 G/A) polymorphism were characterized by amplification and restriction fragment length polymorphisms (RFLP) analysis. RESULTS: VNTR polymorphism in the 3' untranslated region of DAT (p=0.020) was associated with a diagnosis of depression, but was influenced by age effect. We found that NET-8 polymorphism (p=0.015) in NET gene had significant associations with antidepressant response, as did the allelic variations of the promoter (p<0.0001) and intron2 (p=0.023) region in 5-HTT gene. The choice of drug had no effect on drug responsiveness. CONCLUSIONS: These results suggest that allelic variations of 5-HTT and NET genes affect the antidepressant responsiveness.
3' Untranslated Regions ; Antidepressive Agents ; Biogenic Amines* ; Depression ; Depressive Disorder, Major ; Diagnosis ; DNA ; Dopamine Plasma Membrane Transport Proteins ; Humans ; Introns ; Norepinephrine Plasma Membrane Transport Proteins ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Polymorphism, Restriction Fragment Length ; Promoter Regions, Genetic ; Serotonin Plasma Membrane Transport Proteins ; Synaptic Transmission

PURPOSE: Neonatal jaundice is one of the most common problems in our country leading to hospitalization. Agar is low cost, low risk, and easily fed orally; it can bind bilirubin in the intestine, decreasing its enterohepatic circulation, thereby decreasing serum bilirubin levels. At present, however, the effectiveness of agar in the prevention and treament of neonatal jaundice is quite conflicting and controversy. Recently we have read Caglayan's 'Superiority of Oral Agar and Phototherapy Combination in the Treatment of Neonatal Hyperbilirubinemia'. The result was very hopeful and attractive enough, and which gave us a motivation to study if it was really of value. METHODS: From May 1995 to April 1996, a total 50 term neonates admitted in nursery of Dong-Eui Medical Center with the capillary serum bilirubin levels greater than 10mg/ dl were enrolled in the study. Those with pathologic causes and breast fed infants were all excluded. The neonates were randomly devided into two groups; 25 of conventional phototherapy alone (P group) and 25 of oral agar plus conventional phototherapy combination (A+P group). The study was terminated when the capillary serum bilirubins were decreased to 8mg/dl. Pastagar B (Pasteur Institute 64946) 500mg in 10ml distilled water were fed four times a day using 10ml syringes prior to bottle feeding. Capillary serum bilirubin levels were measured daily at 10:00 a.m. with heel pad samples. Daily stool frequency and adverse effects of treatment were observed closely. RESULTS: 1) The decrement of the serum bilirubin levels at first 24 hours of therapy was significantly different between P and A+P groups showing as 1.7+/-1.2 and 2.4+/-1.0mg/dl respectively (p<0.05). 2) Mean time for bilirubin to decrease to 8mg/dl was shorter in A+P group than in P group showing as 45.7+/-20.8 and 57.5+/-32.3 hours each other, but those differences were statistically insignificant (p>0.05). 3) No adverse effects such as rashes or abdominal pains were observed during treatment. Differences of mean stool frequency were significant between P and A+P groups showing as 3.7+/-1.2 and 4.7+/-2.0 times per day respectively (p<0.05). CONCLUSION: The agar plus conventional phototherapy combination was superior to conventional phototherapy alone at first 24 hours of therapy in neonatal hyperbilirubinemia, but further more careful researches would be necessary for using it routinely in the treatment of neonatal hyperbilirubinemia in future.
Abdominal Pain ; Agar* ; Bilirubin ; Bottle Feeding ; Breast ; Capillaries ; Enterohepatic Circulation ; Exanthema ; Heel ; Hope ; Hospitalization ; Humans ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Intestines ; Jaundice, Neonatal ; Motivation ; Nurseries ; Phototherapy* ; Syringes ; Water

PURPOSE: Bilirubin values may vary depending on the site of sampling. The purpose of this study is to compare simultaneously obtained capillary and venous serum bilirubin to assess neonatal jaundice. METHODS: The subjects for the study included 135 healthy inborn as well as outborn full-term infants admitted to Dong-Eui Medical Center for evaluation of jaundice from May 1997 to February 1999. A paired capillary and venous sample was simultaneously drawn from each neonate, and their serum bilirubins were measured by direct spectrophotometric method. RESULTS: A high correlation between capillary and venous serum bilirubin(correlation coefficient(r) =0.949, P<0.05) was observed. No significant difference between mean capillary and venous bilirubin was detected when capillary bilirubin was less than 10 mg/dL(P>0.05), however, the mean venous bilirubin was significantly higher than the mean capillary bilirubin(mean difference;0.65+/-1.04 mg/dL, P<0.0001) when the capillary bilirubin was greater or equal to 10 g/dL(P>0.05). CONCLUSION: There was a trend toward venous bilirubin being higher than capillary bilirubin at higher serum bilirubin levels. However, further studies are needed to ascer-tain the relationship between the site of the sampling and methodology in measurement of bilirubin.
Bilirubin* ; Capillaries* ; Humans ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal*

Injury of lower cranial nerves (CNs) by skull base fracture after head trauma can occur sometimes. However, selectively different CN damage on either side is extremely rare.A 53-year-old man had difficulty of swallowing, phonation, and articulation after falling off his bicycle. In physical examination, a deviated tongue to the right side was shown.Brain computed tomography showed a skull base fracture involving bilateral jugular foramina and right hypoglossal canal. Left vocal cord palsy was confirmed by laryngoscopy. Electromyography confirmed injury of left superior laryngeal nerve, recurrent laryngeal nerve, and right hypoglossal nerve. Video fluoroscopic swallowing study revealed large amounts of remnant in vallecula and pyriform sinus without opening of upper esophageal sphincter due to dysfunction of cricopharyngeus muscle. After constant rehabilitation for dysphagia, he was allowed to eat a general diet with compensatory techniques at discharge and further recovery after 3 months. Injury of lower CNs after fracture of the skull base can cause severe morbidity. However, the prognosis of such injuries can be favorable with early rehabilitation treatment by identifying the injured CN. A careful and accurate examination of lower CN injury in skull base fracture is essential for planning a treatment strategy.