Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Cardiology ; Enzyme-Linked Immunosorbent Assay ; Fingers ; Fluorescent Antibody Technique, Direct ; Granuloma ; Hand ; Hemorrhage ; Humans ; Hypertension ; Microscopic Polyangiitis* ; Middle Aged ; Myocardial Infarction* ; Neck ; Pancreatitis ; Sepsis ; Vasculitis

OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.
Aspartic Acid ; Blood Urea Nitrogen ; Cause of Death ; Chemistry, Clinical ; Creatinine ; Enterovirus ; Hepatic Encephalopathy ; Hepatitis* ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Mortality ; Muscle Weakness ; Myositis* ; Paralysis ; Phosphotransferases ; Prognosis ; Prothrombin Time ; Serum Albumin

Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.
Abdomen ; Abdominal Pain ; Bezoars ; Bulimia* ; Child, Preschool ; Diagnosis ; Diaphragm* ; Duodenal Obstruction ; Duodenum ; Failure to Thrive ; Female ; Humans ; Membranes ; Parturition ; Vomiting ; Weight Gain ; X-Ray Film

Purpose of this study was to compare nutrient intakes of disabled children and non-disabled children. Subjects consisted of 86 disabled children from a special education school and 127 non-disabled children from an elementary school in Seoul. Nutrient intakes were assessed by modified 24-hr recall method, with the help of children's parents and teachers. Almost all nutrient intakes (energy, protein, fat, carbohydrates, vitamin B1 and niacin) of children with cerebral palsy were significantly lower than those of other groups. But nutrient intakes per body weight of children with cerebral palsy were not significantly different with those of other groups. There was no significant difference between disabled and non-disabled children in almost % RDA (rate of actual intake to RDA) except of energy %RDA in children with cerebral palsy. NARs (nutrient adequacy ratio) for energy and vitamin B1 of children with cerebral palsy were significantly lower than those of children with autism and mental retardation, and non-disabled children. The proportions of energy, carbohydrate and protein intakes from lunch were significantly higher than those from breakfast and dinner in children with mental retardation and autism. The nutrient intakes of disabled children were different between other groups according to the type of handicap. For example, children with cerebral palsy had the risk of undernutrition. On the other hand, autistic children had the tendency of overnutrition. These results suggest that nutrition educational programs and educational materials for disabled children, their teachers and their parents should be developed considering the type of handicap.
Autistic Disorder* ; Body Weight ; Breakfast ; Carbohydrates ; Cerebral Palsy ; Child* ; Disabled Children ; Education, Special ; Hand ; Humans ; Intellectual Disability ; Lunch ; Malnutrition ; Meals ; Overnutrition ; Parents ; Seoul ; Thiamine

OBJECTIVES: This study is designed to develop a large group phychodrama for light delin-quent adolescents (hereinafter called as "Psychodrama") thereby determining therapeutic factors for dealing with them. METHODS: The study was conducted in the program of Seoul Metropolitan Youth Centre called "the class of love" during the period of July through December, 1998. The subjects consisted of a total of 827 young delinquents (759 boys and 68 girls, with the average age of 15.9 years old). To develop "this psychodrama", after we composed of therapeutic team centered by psychiatrists, we prepared from January to June, 1998 by practicing psychodrama with delinquent adolescents and by analyzing the results. "This psychodrama" has three basic steps: (1) warming-up (small group me-eting), (2) action (situation drama and main drama), (3) sharing. A survey of treatments, from a pool of participating adolescents, based on evaluation sheets and 13 therapeutic factors scale followed every session of this psychodrama. RESULTS: "This psychodrama" was helpful for 47.4%, interesting for 49.2%, not helpful for 12.1% and not interesting for 16%. In the whole group of subjects, the important therapeutic factors were existential factor, universality, identification with the therapist and the instillation of hope in the order of rank. When categorized in four different groups (audience, participants in situation drama, auxiliary egos, participants in sharing) the 4 groups displayed different results to one another. First, the therapeutic factors of audience were similar to that of the whole group. Second, participants in situation drama showed a higher catharsis than others. Third, auxiliary egos were leading in the guidance of members and therapists. Fourth, participants in sharing displayed higher group cohesiveness. CONCLUSION: As it is getting harder to find program's suitable for the treatment of increasing number of delinquents due to limited budget and experts, this psychodrama could be more cost-effective than any other measures.
Adolescent* ; Budgets ; Catharsis ; Drama ; Ego ; Female ; Hope ; Humans ; Psychiatry ; Psychodrama* ; Seoul

OBJECTIVES: The dysfunctional neural networks underlying self-evaluation in schizophrenia are overlapped with the neural structures involved in emotion regulation. The purpose of this study was to investigate the influence of anhedonia on the self-evaluation attitude of patients with schizophrenia. METHODS: Twenty healthy controls and twenty patients with schizophrenia performed a self-evaluation task, presenting a pair of the face (self, familiar other, and unfamiliar other) and word (negative, neutral, and positive noun) at the same time. Participants were asked to evaluate relevance between the pairs by pressing a corresponding button. Relevance rating scores were compared between the groups and were correlated with the severity of physical and social anhedonia. RESULTS: Patients evaluated the condition of a self face with a negative word and a familiar face with a negative word to be more relevant than healthy controls. In the patient group, the scores of relevance rating in the condition of an unfamiliar other face with a negative word were positively correlated with the anhedonia scale scores (physical : r=0.486, p=0.030 ; social : r=0.499, p=0.025). There was no correlation between the self-evaluation attitude and the severity of anhedonia. CONCLUSION: Patients with schizophrenia evaluate themselves badly in only negative circumstances, and anhedonia is not related to self-evaluation, but rather other-evaluation.
Anhedonia* ; Diagnostic Self Evaluation ; Humans ; Schizophrenia*

BACKGROUND: Depression is the leading cause of lowering the quality of life of cancer patients and lung cancer is the most likely to cause depression. It is necessary to find out depression-related factors in lung cancer patients. METHODS: The study was a retrospective cohort study using medical records, and was a non-equivalent comparison group design. It involved patients diagnosed of lung cancer at the Konkuk University Medical Center from January to December 2012. Between antidepressants prescription group and non prescription group, socio-demographic factors, clinical factors, treatment-related factors and other factors were analyzed statistically. RESULTS: Antidepressant prescription group consisted of 23 people and non-prescription group of 206 people. Prescription rate of quetiapine was the highest 47.8% (11/23), followed by escitalopram (43.5%, 10/23), amitryptyline and trazodone (30.4%, 7/23). The prescription group was prescribed with an average of 1.9 antidepressants. Antidepressants were prescribed after average of 248 days from lung cancer diagnosis and prescription period per patient was average 177.5 days. According to the result of univariate logistic regression analysis between 2 groups, factors such as number of outpatient visit, number of admission, days of hospitalization, sleep disorder, and comorbidity were found to be statistically significant (p < 0.05). However, According multivariate logistic regression analysis showed that number of admission, days of hospitalization and sleep disorder were statistically significant (p < 0.05) excluding comorbidity. CONCLUSION: About 10% of lung cancer patients had received a prescription for antidepressants after lung cancer diagnosis. A sleep disorder, number of hospitalization and length of stay were identified as factors influencing the prescribing antidepressants.
Academic Medical Centers ; Antidepressive Agents* ; Citalopram ; Cohort Studies ; Comorbidity ; Depression ; Diagnosis ; Hospitalization ; Humans ; Length of Stay ; Logistic Models ; Lung Neoplasms* ; Lung* ; Medical Records ; Outpatients ; Prescriptions ; Quality of Life ; Quetiapine Fumarate ; Retrospective Studies ; Sleep Wake Disorders ; Trazodone

Some of the proteins of mycobacteria are preferentially associated with the cell wall and are powerful immunogens, and humoral antibody responses to these mycobacterial antigens may occur in patients with tuberculosis. In this study, Triton X-100 solubilized protein (TSP) antigen was isolated from Mycobacterium tuberculosis H37Rv by overnight shaking with 1% Triton X- 100/PMSF and 10-90% ammonium sulfate precipitation. IgG and IgM antibody levels against TSP, crude protein from the unheated cultrue filtrate (CF#) and 30 kDa antigens were determined in the sera of 80 patients with pulmonary tuberculosis and 99 healthy controls with PPD (+) and (-). High IgG reactivity to TSP and CF antigen was observed in tuberculosis patients. Mean IgG antibody titers against all of three mycobacterial antigens were differed significantly (P<0.01) between patients and controls but IgM showed no difference. By the cut-off value adding 2 standard deviation to the mean absorbance of controls, the sensitivity and specificity of the IgG antibody to TSP antigen were 93.9% and 77.5%. The specificity to TSP antigen was a litttle higher than those obtained by CF and 30 kDa antigen. From the above results, the TSP antigen may be useful for the serodiagnosis of tuberculosis.
Ammonium Sulfate ; Antibody Formation ; Cell Wall ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Mycobacterium tuberculosis* ; Mycobacterium* ; Neptune* ; Octoxynol* ; Sensitivity and Specificity ; Serologic Tests ; Tuberculosis ; Tuberculosis, Pulmonary*

PURPOSE: This purpose of this study was to identify the factors related to the health related quality of life among institutionalized elders. METHODS: The subjects were 247 elders institutionalized among one of the four nursing homes in Busan. Data were collected through interview with four standardized questionnaires from August to October, 2008. Questionnaires were related to health related quality of life (SmithKline Beecham's Quality of Life scale, SBQoL), quality of sleep(Pittsburgh Sleep Quality index, PSQI), activity of daily living (Katz ADL Index), and depression (Geriatric Depression Scale Short Form Korea, GDSSF-K). Data were analyzed for descriptive analysis, t-test, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression by using SPSS/WIN 17.0 program. RESULTS: The mean HRQoL in the subjects was 6.62 +/- 0.91. Percentage of the respondents reporting sleep disorders were 72.5% and 27.1% reported being vulnerable to depression. The significant predictors of the HRQoL were sleep quality, activity of daily living (ADL), level of education, and depression. The factors accounted for 28.8% of variance in the health related quality of life of institutionalized elders. CONCLUSION: Sleep quality, activity of daily living, and depression need to be considered as the important control factors for improving the health related quality of life in the institutionalized elders.
Activities of Daily Living ; Depression ; Korea ; Nursing Homes ; Quality of Life ; Sleep Wake Disorders ; Surveys and Questionnaires

BACKGROUND: Gender and social relationships are believed to have a strong influence on health care attitudes and behavior. This study was designed to determine the effect of the gender of closely associated persons on t,he health care-seeking behavior of persons of the oppsite sex. METHODS: We developed a 10-item questionnaire that requested information on social and demographic characteristics, health status, and influences on the decision to seek health care, and administered it to 314 consecutive patients seen at two family medicine clinics in Seoul. Data were analyzed by means of one way analysis of variance for continuous variables and the chi-square test for categorical variables. Additionally, data were analyzed by means of a multivariate logistic regression model that calculated odds ratios and 95% confidence intervals. RESULTS: Men were 4.6 times more likely to be influenced than women to seek health care by a member of the opposite sex(95% CI, 2.4 to 8.9). CONCLUSIONS: Women make an important influene on the decisions for men to seek health care.
Delivery of Health Care ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Seoul ; Surveys and Questionnaires