BACKGROUND: Because of many physical, psychological, and social stresses, adolescence is a vulnerable period to psychiatric disorders. But in Korea, there is actually not enough time for primary care physicians to screen such patients during ordinary medical interviews. Therefore this research was done to develop and validate a brief screening questionnaire for the detection of adolescent patients with psychiatric problems. METHODS: Three family physicians in charge of their own adolescent clinics developed a five-item questionnaire for screening adolescents with psychiatric problems by reviewing related literature with consultation by a psychiatrist. After performing a pretest and gathering second opinions from other psychiatrists and nurse-teachers, final questionnaire was redeveloped. Verification of its reliability by using test-retest method and internal consistency by calculating Cronbach's alpha coefficient was done. Also inspection of its validity by comparing the scores of psychiatric patient group to normal group was done. And finally the discrimination point was obtained. RESULTS: For reliability Kappa value of new questionnaires ranged from 0.33 to 0.63. One item was dropped because of its negative influence to the internal consistency and the discrimination power. With the four final items, we estimated the validity for distinguishing psychiatric patients from the normal group by calculating the sensitivity and specificity of each cutting point of scores. For the each cutting point 1, 2, and 3, sensitivity was 85%, 75%, 40%, respectively, and specificity was 27%, 62%, 84%, respectively. We considered score 1 as the best cutting point because the purpose of the questionnaire was screening rather than diagnosis. CONCLUSION: A brief four-item screening questionnaire(SAPPO. Screening method of Adolescent Psychiatric Problems in Outpatient clinic) was developed and its reliability and validity was estimated.
Adolescent* ; Diagnosis ; Discrimination (Psychology) ; Humans ; Korea ; Mass Screening* ; Outpatients ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care* ; Psychiatry ; Referral and Consultation ; Reproducibility of Results ; Sensitivity and Specificity ; Surveys and Questionnaires

Adrenal insufficiency during the treatment of pulmonary tuberculosis is a troublesome condition and can at times be lifethreatening if untreated. Rifampin is one of the most widely prescribed anti-tuberculosis agents. Furthermore, rifampin has been known to be capable of affecting the metabolism of various medications, including glucocorticoids. In this paper, a case of recurrent adrenal insufficiency induced by rifampin during the treatment of pulmonary tuberculosis is reported. The patient was a 63-year-old man who was diagnosed with Addison's disease 17 years earlier and had been undergoing glucocorticoid replacement therapy. Five months before, the patient manifested pulmonary tuberculosis and was immediately given anti-tuberculosis medication that included rifampin. After one week of medication, general weakness and hyponatremia occurred. Despite the increased dose of the glucocorticoid medication, the adrenal insufficiency recurred many times. Since the substitution of levofloxacin for rifampin, the episodes of adrenal insufficiency have not recurred so far.
Addison Disease ; Adrenal Insufficiency ; Glucocorticoids ; Humans ; Hyponatremia ; Middle Aged ; Ofloxacin ; Rifampin ; Tuberculosis, Pulmonary

No abstract available.
Intubation, Intratracheal* ; Lacerations*

Total anomalous pulmonary venous confluence(TAPC), a rare cyanotic congenital anomaly of the heart especially in adult, is now diagnosed by echocardiography instead of cardiac catheterization with high sensitivity and specificity. The key points are identification of pulmonary veins, pulmonary venous confluence draining anomalously to the heart. RVDVO on M-mode, abnormal echo free space posterior to left atrium on 2D-echo are basic characteristics of TAPVC. Peak velocity and flow profile measurement on the doppler provide additional informations : obstruction and anomalous vessels. A case of 23 year old male with supracardiac type TAPVC diagnosed by echocardiography was corrected successfully by surgery.
Adult* ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Heart ; Heart Atria ; Humans ; Male ; Pulmonary Veins ; Sensitivity and Specificity ; Young Adult

Spontaneous coronary artery dissection is a rere incident occurring usually in young patients, predominautly in females. It is usually fatal and found postmortem. It is also a rare cause of acute myocardial infarction. We present the case of a twenty nine-year-old-man with spontaneous right coronary artery dissection found angiographically which caused an inferior wall myocardial infarction. He was treated with medical therapy only amd after uneventful hospital course, he was discharged with medication. Three months later, coronary angiography was done to follow up the lesion and found that the site was completely healed.
Coronary Angiography ; Coronary Vessels ; Female ; Follow-Up Studies ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction*

BACKGROUND AND OBJECTIVES: Certain types of arrhythmias have gender differences. Women have a higher incidence of drug-induced QT prolongation than in men. However, there are no reports regarding gender-related differences of the P wave signal averaged electrocardiogram (PWSAE), based on the risk of atrial fibrillation (AF). PWSAE has been recognized as a diagnostic tool for identifying the risk of paroxysmal atrial fibrillation (PAF). We therefore investigated the influence of gender in the parameters of PWSAE and in the risk of AF. SUBJECTS AND METHODS: We recorded 100 PWSAEs in apparently healthy Korean subjects (53 men and 47 women), aged 20 to 79 years. RESULTS: The mean age of the male subjects was 38.2 years and the mean age of the female subjects was 43.2 years (p=0.19). The body surface area (BSA) were larger in men (1.83 m2 vs. 1.53 m2, p<0.05). In men, the filtered P wave duration (fPD) was longer than in women (136.8 msec vs. 125.2 msec, p<0.05). The root mean square voltage in the terminal 20 ms of the filtered P wave (RMS20) was 5.9 micron V in women and 4.5 micron V in men (p<0.05). CONCLUSION: Men have a longer fPD and lower RMS20 than women. The BSA showed a positive correlation with fPD and a negative correlation with RMS20. This study suggests that BSA is an important factor for fPD and RMS20. In addition, as men have a larger BSA as compared with women, we suspect that men have a higher risk of AF as compared with women.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Body Surface Area ; Electrocardiography* ; Female ; Humans ; Incidence ; Male

Most of swallowed foreign bodies pass spontaneously. However, sharp objects are usually lodged in the proximal esophagus and cause aspiration, bleeding, obstruction, and perforation. Therefore, prompt retrieval of lodged foreign bodies are necessary. The safe extraction of sharp foreign bodies using endoscopic technique is difficult because sharp objects carry a significant risk of mucosal injury and perforation. Endoscopic techniques for retrieval of foreign body include methods using protector hood and overtube. The former is not available, the later is uncomfortable and its diameter is the limiting factor. Method using a latex glove is available, comfortable, and its diameter is not limited. The thickness of the glove is thinner than protector hood, but we think that a latex glove would seem to be a effective alternative. We report a case in which a sharp foreign body was endoscopically removed using a latex glove without complication.
Esophagus ; Foreign Bodies* ; Hemorrhage ; Latex*

PURPOSE:Hypoxic injury during delivery and subsequent ischemic encephalopathy is still remained as one of the important cause of neonatal death and associated with neurologic complication. We investigated the predicting factors for neurologic outcome in full-term hypoxic-ischemic encephalopathy (HIE). METHODS:Twenty-two full-term neonates with HIE stage II or III from Jan. 2001 to Dec. 2004 were enrolled. We reviewed the medical records retrospectively including obstetric history, initial pH, creatine kinase (CK), ionized calcium, seizure type and duration, EEG, cranial sonography, CT or MRI, and neurologic outcome. RESULTS:Among 22 patients, outborn was 86.3%, vaginal delivery 68.2%, and male 72.7%. Regarding the obstetrical events, two-thirds had meconium staining or aspiration and prolonged rupture of membrane. Initial arterial pH, CK and ionized calcium were not significantly different between normal and abnormal neurologic outcome group. All of 5 patients recovered from seizure after more than 5 days had neurologic sequelae (P= 0.008). Eight of 16 cases with abnormal EEG showed abnormal development, and all of 4 cases with normal EEG showed normal development. Eight of 12 cases with abnormal imaging study showed neurologic sequelae, however, all of 10 cases with normal study showed normal outcome (P=0.005). CONCLUSION:This study suggests that seizure duration and imaging study are the best predicting factors for prognosis in full-term HIE. Although the EEG finding was not signigicant, the normal finding is expected to have good prognosis. The initial laboratory findings had no prognostic significance because of delayed blood sampling in most patients, who transferred from other hospitals after immediate postnatal resuscitation. We encourage the maternal transport especially when the high-risk delivery is anticipated.
Brain Ischemia ; Calcium ; Creatine Kinase ; Electroencephalography ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain* ; Infant, Newborn* ; Magnetic Resonance Imaging ; Male ; Meconium ; Medical Records ; Membranes ; Prognosis ; Resuscitation ; Retrospective Studies ; Rupture ; Seizures

PURPOSE: To determine changes in the signal intensity of intracerebral hemorrhagic lesions according to the time interval, between the onset of symptoms and MR imaging in the T1-weighted (T1W1), T2-weighted (T2W1) and diffusion-weighted modes. MATERIALS AND METHODS: Thirty-four patients with hemorrhagic stroke who underwent DWI and conventional MRI were involved in this study. Hemorrhagic phase was determined according to the time interval between the onset of symptoms and MR scanning, and was as follows: acute (3 days or less): eight patients); early subacute (7 days or less): ten patients; late subacute (4 weeks or less): seven patients; early chronic (3 months or less) : four patients); and late chronic (more than 3 months): five patients. Using a 1.5T MR imager and the single-shot echo-planar imaging technique, T1-weighted, fast spin-echo T2-weighted, and diffusion-weighted were obtained. In all cases qualitative signal intensity (SI) at the center of a lesion was recorded, and the ratio between this and normal brain parenchyma was calculated. RESULTS: SI at the center of a lesion was found to be iso or high/high/high (T1WI/T2WI/DWI) in five of eight acute-phase cases (interval of 24 hours or less) and low/low/low in the remaining three (interval of 72 hours or less). Other signal intensities were as follows: early subacute phase: high/low/low (all ten cases); late subacute phase: high/high/high (all seven cases); early chronic phase: high/high/high (all four cases); late chronic phase: low/high/low (all five cases). Mean SIRs were as follows: in the five acute-phase cases in which SI was iso or high: 1.42+/-0.78 / 2.58+/-0.84 / 1.35+/-0.08 (T1WI / T2WI / DWI); in the remaining three acute-phase cases: 0.94 +/-0.18 / 0.63+/-0.16 / 0.27+/-0.10; in the early subacute phase, 1.35+/-0.01 / 0.97+/-0.21 / 0.86+/-0.22 in early subacute phase, 1.58+/-0.04 / 1.54+/-0.09 / 1.44+/-0.14; in the early chronic phase: 1.26+/-0.11 / 1.06+/-0.14 / 0.97+/-0.12; and in the late chronic phase: 0.65+/-2.23 / 1.51+/-0.12 / 0.23+/-0.18. CONCLUSION: The DWI findings of intracerebral hemorrhage reflect the findings of T2WI. When interpreting the DWI findings in patients with intracerebral hemorrhage, an understanding of the temporal evolution of this is very helpful.
Brain ; Cerebral Hemorrhage ; Diffusion* ; Echo-Planar Imaging ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Stroke

BACKGROUND: New antitumor therapeutic strategies aim to combine different approaches that are able to induce tumor-specific effector and memory T cell responses that might control tumor growth. Dendritic cells (DCs) have the capacity to induce antigen-specific cytotoxic T lymphocytes. We have previously shown that the combined treatment of paclitaxel chemotherapy (Chemo) and injection of DCs led to complete tumor regression. OBJECTIVE: The goal of this study was to evaluate synergistic antitumor effect of a triple combination treatment comprising radiotherapy, paclitaxel Chemo and intratumoral injection of syngeneic bone marrow-derived DCs on murine fibrosarcoma, compared to other single or double combination treatments. METHODS: For the murine fibrosarcoma model, naive C57BL/6 mice were inoculated intradermally with 2x10(3) MCA102 cells in the right upper flank. Mice were assigned to five groups (untreatedcontrol, RT alone, RT+Chemo, RT+DC, and RT+Chemo+DC), with eight mice in each group. In vitro cytotoxicity assays were performed to assess the immune activity. The persistence of tumor-specific immunity was determined by second tumor challenge in mice with complete tumor regression. RESULTS: The triple combination treatment showed a significantly enhanced therapeutic efficacy by decreasing tumor size and inducing complete tumor regression, resulting in a cure of 50% of mice. The results of in vitro cytotoxicity assays and the second tumor challenge experiment strongly indicated the induction of a tumor-specific cytotoxic T lymphocyte response and acquisition of prolonged tumor immunity. CONCLUSION: These findings suggest that the triple combination treatment can be a promising strategy for the treatment of murine fibrosarcoma.
Animals ; Combined Modality Therapy ; Dendritic Cells* ; Drug Therapy* ; Fibrosarcoma* ; Lymphocytes ; Memory ; Mice ; Paclitaxel ; Radiotherapy* ; T-Lymphocytes, Cytotoxic