Hypoglycemia sometimes manifests as focal neurologic deficits simulating cerebrovascular disease. Symptoms are usually resolved by glucose infusion, but persistent hemiplegia is rarely reported. A 68-year-old diabetic woman on oral hypoglycemic agent(OHA) was admitted with right hemiplegia and global aphasia. Blood glucose level was 29 mg/dl on admission. No evidence of cerebral infarct or underlying brain disease could be found on initial brain CT and follow up MRI. Focal stenosis or occlusion was also absent on MR angiography. Hemiplegia and aphasia were not improved despite adequate therapy. Hypoglycemic hemiplegia should be suspected in all diabetic patients using insulin or OHA with stroke-like episode, and we suggest that prolonged hypoglycemia may be related to persistence of neurologic deficits.
Aged ; Angiography ; Aphasia ; Blood Glucose ; Brain ; Brain Diseases ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Glucose ; Hemiplegia* ; Humans ; Hypoglycemia ; Insulin ; Magnetic Resonance Imaging ; Neurologic Manifestations

Korean Americans (KAs) with psychiatric service needs underutilizes the mainstream mental health services in United States (US). Barriers to mental health service access among KAs reflect their unique heritage and culture. More than two-thirds of KAs identify themselves as Christians, and Korean clergy have influential roles in daily lives of vast majority of KAs. By working with the Korean clergy, a small voluntary organization such as the Association of Korean American Psychiatrists could provide invaluable assistance in removing the barriers to mental health services for KAs.
Asian Americans* ; Clergy ; Emigrants and Immigrants* ; Emigration and Immigration ; Humans ; Mental Health Services* ; Psychiatry ; United States

OBJECTIVE: To correlate the MRI findings in acute and chronic stage of Wemicke encephalopathy with the well-known clinical and pathologic findings. Background. Wemicke encephalopathy is an acute phase of Wemicke-Korsakoff syndrome. Pathologic findings change between acute and chronic phases. Only a few MRI studies have been done in this disease to date. METHODS: Ten consecutive patients with Wemicke encephalopathy were evaluated with MRI; seven within 24 hours of thiamine treatment, and three between 2 and 4 days. They presented with confusion, ophthalmoplegia and gait ataxia which improved with intravenous thiamine. Korsakoff psychosis became evident on followup. Tl-, proton- and T2-weighted axial images were obtained with additional 5 mmthick Tl-weighted sagittal and coronal images to evaluate the morphology and size of the mammillary body. RESULTS: Increased T2 signal was seen in the periaqueductal area in seven(sometimes involving superior colliculus); medial thalamus in five; and splenium of the corpus callosum in two. Among the seven patients with T2 signal abnormalities, five had follow-up MRI in 2 to 70 days, which showed complete resolution of the abnormalities. Seven patients showed atrophy of mammillary body on the initial MRI. In the three patients who had normal mammillary body in size on initial scan, follow up MRI revealed atrophic change of mammillary body. Tlweighted sagittal image showed superior cerebellar vermis atrophy in seven. Four patients revealed dilatation of the third ventricle. CONCLUSION: MRI findings of Wernicke encephalopathy appear diagnostic in acute stage and may reflect the pathological evolution in acute and chronic phases of Wernicke-Korsakoff syndrome.
Atrophy ; Corpus Callosum ; Dilatation ; Follow-Up Studies* ; Gait Ataxia ; Humans ; Korsakoff Syndrome ; Magnetic Resonance Imaging* ; Mamillary Bodies ; Ophthalmoplegia ; Thalamus ; Thiamine ; Third Ventricle ; Wernicke Encephalopathy*

OBJECTIVE: Korean American Elderly (KAE) have high rates of depression but underuse mental health services. The purpose of this study was to assess the meaning of depression and help seeking among KAE residing in the United States who have clinically significant depressive symptoms. METHODS: As a follow up to the Memory and Aging Study of Koreans (MASK; n=1,118), a descriptive epidemiological study which showed that only one in four of KAE with clinically significant depressive symptoms (Patient Health Questionnaire-9≥10) used mental health services, we conducted a qualitative study using semi-structured interviews with participants with clinically significant depressive symptoms regarding the meaning of depression and beliefs about help seeking. Ten participants with clinically significant depressive symptoms were approached and 8 were recruited for semi-structured interviews. RESULTS: KAE did not identify themselves as depressed though experiencing clinically significant depressive symptoms. They associated depression with social discrimination, social isolation, and suicide in the extreme circumstance. They attributed depression to not achieving social and material success in America and strained relationships with their children. Participants attempted to self-manage distress without telling others in their social network. However, KAE were willing to consult with mental health professionals if the services were bilingual, affordable, and confidential. CONCLUSION: KAE with clinically significant depressive symptoms are a vulnerable group with need and desire for linguistically and culturally relevant mental health services who are isolated due to a complex array of psychological and social factors.
Aged* ; Aging ; Americas ; Asian Americans* ; Child ; Depression* ; Epidemiologic Studies ; Follow-Up Studies* ; Humans ; Memory ; Mental Health ; Mental Health Services ; Qualitative Research ; Social Discrimination ; Social Isolation ; Suicide ; United States

PURPOSE: Cockroaches have been reported one of the major causes of allergic disease such as bronchial asthma and allergic rhinitis. About 10% of children and 20% of adult respiratory allergy patients have positive results of allergy skin tests to cockroach allergen. This finding suggests that cockroach is also important allergen in Korea. Among 4,000 species, German cockroach seems predominant species in the Korean peninsula. Identification and charactrerization of the major allergen is the first step in German cockroach allergen research. But, there have been controversies. It may depends upon different identifying methods. The aim of our study was to identify the major allergen in German cockroach using Westernblot. METHODS: Crude German cockroach allergen extracts with or without protease inhibitor cocktail mixture were prepared, and protein patterns of these two extracts were compared using SDS-PAGE and Coommssie stain. Sera from 32 atopic asthmatic patients with positive allergy skin test against cockroach allergen were used for IgE immunoblot. RESULTS: Coomassie stain after SDS-PAGE demonstrated some discordance between the differently prepared crude allergen extracts. In comparison with the allergen extract which abolished endogenous protease activity, the untreated extract revealed new 32, 55 and 78 kD protein bands and 41 kD protein band was disappeared. About 60% of sera with positive allergy skin test revealed IgE binding bands in Westernblot. Among them, 10, 21, 25, 36 and 52 kD protein band might seemed important German cockroach allergen. CONCLUSION: Finding above may suggest that endogenous protease could denature allergenic proteins in the process of crude cockroach allergen extract. The 10, 21, 25, 36, and 52 kD might be the important allergens in German cockroach.
Adult ; Allergens ; Asthma ; Blattellidae* ; Child ; Cockroaches ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Protease Inhibitors ; Rhinitis ; Skin Tests

PURPOSE: This study was conducted to assess clinical practices related to the evaluation and treatment of patients with acute gastrointestinal infection(AGI) in infants and children. This survey also evaluated the current opinion regarding the use of rotavirus vaccine. METHODS: This survey was conducted using a self-administered questionnaire provided to 82 pediatricians in private clinics of Jeonbuk province. From April to June, 2002, 63 of 82 pediatricians(76.8 %) responded to the survey. RESULTS: The annual proportion of patients with AGI was 13%. The highest proportion of patients with diarrhea were reported for the months of October through December. For the treatment of diarrhea, pediatricians preferred to prescribe lactobacillus products, oral rehydration solution, enzyme products, anti-emetics, anti-diarrheal formula, nothing by mouth(NPO) and bowel movement inhibitors in descending order of frequency. Most pediatricians(79.4%) prescribed antibiotics in less than 20% of patients with AGI. Amoxicillin was the most commonly prescribed antibiotics followed by trimethoprim/sulfamethoxazole(TMP/SMX) and amoxicillin/clavulanate. Clinical manifestations that pediatricians considered as important factors in prescribing antibiotics were bloody diarrhea, mucoid diarrhea, high fever, persisting disease and abdominal pain. Diagnostic procedures that pediatricians preferred for AGI patients were stool examination(rotavirus antigen, RBC, WBC), abdominal X-ray, and serum electrolytes. Pediatricians had a strong interest in rotavirus vaccine(71.4%). CONCLUSIONS: Acute gastrointestinal illness remains a common problem, especially during the winter months in Korea. AGI manifesting as watery diarrhea is appropriately treated with commonly available agents but pediatricians appear ready to consider additional approaches to decrease the sizable disease burden of AGI among children in Korea.
Abdominal Pain ; Amoxicillin ; Anti-Bacterial Agents ; Antiemetics ; Child ; Diarrhea ; Electrolytes ; Fever ; Fluid Therapy ; Humans ; Infant ; Jeollabuk-do* ; Korea* ; Lactobacillus ; Surveys and Questionnaires ; Rotavirus

Etretinate(Ro 10-9359), an aromatic analogue of vitamin A acid, has been known to be effective in the treatment of psoriasis, Darier's disease, pityriasis rubra pilaris, ichthyosis, and palmoplantar keratoderma when administered orally. In this experiment, we compared the therapeutic and side effects between a group with high dose therapy(initially 75mg of etretinate a day) and an another group with low dose therapy(initially 40mg of etretinate a day). We also observed whether the pretreatment followed by combined treatment with vitamin E could potentiate the therapeutic effect as well as reduce the side effects of oral etretinate. This experiment comprised 102 moderate to severe psoriatic patients. The following results were obtained from this experiment. 1. Fifty-six among 92 patients(61%) who were treated with etretinate for more than 4 weeks showed good to excellent therapeutic effect. 2 The high dose therapy was more effective, but showed more side effects than low dose therapy. 3 Vitamin E did not potentiate the effect of etretinate. In low dose therapy, the pretreatment followed by combined treatment with vitamin E showed a tendency to reduce the side effects of etretinate.
Acitretin* ; Darier Disease ; Etretinate* ; Humans ; Ichthyosis ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Psoriasis* ; Tretinoin ; Vitamin E* ; Vitamins*

OBJECTIVE: Considering the different prevalence rates of diseases such as asthma and chronic obstructive pulmonary disease in Asians relative to other races, Koreans may have unique airway structure and lung function. This study aimed to investigate unique features of airway structure and lung function based on quantitative computed tomography (QCT)-imaging metrics in the Korean Asian population (Koreans) as compared with the White American population (Whites). MATERIALS AND METHODS: QCT data of healthy non-smokers (223 Koreans vs. 70 Whites) were collected, including QCT structural variables of wall thickness (WT) and hydraulic diameter (Dh) and functional variables of air volume, total air volume change in the lung (ΔVair), percent emphysema-like lung (Emph%), and percent functional small airway disease-like lung (fSAD%). Mann-Whitney U tests were performed to compare the two groups. RESULTS: As compared with Whites, Koreans had smaller volume at inspiration, ΔVair between inspiration and expiration (p < 0.001), and Emph% at inspiration (p < 0.001). Especially, Korean females had a decrease of ΔVair in the lower lobes (p < 0.001), associated with fSAD% at the lower lobes (p < 0.05). In addition, Koreans had smaller Dh and WT of the trachea (both, p < 0.05), correlated with the forced expiratory volume in 1 second (R = 0.49, 0.39; all p < 0.001) and forced vital capacity (R = 0.55, 0.45; all p < 0.001). CONCLUSION: Koreans had unique features of airway structure and lung function as compared with Whites, and the difference was clearer in female individuals. Discriminating structural and functional features between Koreans and Whites enables exploration of inter-racial differences of pulmonary disease in terms of severity, distribution, and phenotype.
Asian Continental Ancestry Group ; Asthma ; Continental Population Groups ; Female ; Forced Expiratory Volume ; Humans ; Lung ; Lung Diseases ; Phenotype ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Thorax ; Trachea ; Vital Capacity

The C-terminal domain of RNA polymerase II is an unusual series of repeated residues appended to the C-terminus of the largest subunit and serves as a flexible binding scaffold for numerous nuclear factors. The binding of these factors is determined by the phosphorylation patterns on the repeats in the domain. In this study, we generated a synthetic antibody library by replacing the third heavy chain complementarity-determining region of an anti-HER2 (human epidermal growth factor receptor 2) antibody (trastuzumab) with artificial sequences of 7–18 amino-acid residues. From this library, antibodies were selected that were specific to serine phosphopeptides that represent typical phosphorylation patterns on the functional unit (YSPTSPS)₂ of the RNA polymerase II C-terminal domain (CTD). Antibody clones pCTD-1stS2 and pCTD-2ndS2 showed specificity for peptides with phosphoserine at the second residues of the first or second heptamer repeat, respectively. Additional clones specifically reacted to peptides with phosphoserine at the fifth serine of the first repeat (pCTD-1stS5), the seventh residue of the first repeat and fifth residue of the second repeat (pCTD-S7S5) or the seventh residue of either the first or second repeat (pCTD-S7). All of these antibody clones successfully reacted to RNA polymerase II in immunoblot analysis. Interestingly, pCTD-2ndS2 precipitated predominately RNA polymerase II from the exonic regions of genes in genome-wide chromatin immunoprecipitation sequencing analysis, which suggests that the phosphoserine at the second residue of the second repeat of the functional unit (YSPTSPS)2 is a mediator of exon definition.
Antibodies ; Chromatin Immunoprecipitation ; Clone Cells ; Complementarity Determining Regions ; DNA-Directed RNA Polymerases* ; Exons* ; Peptides ; Phosphopeptides ; Phosphorylation* ; Phosphoserine ; Receptor, Epidermal Growth Factor ; RNA Polymerase II* ; RNA* ; Sensitivity and Specificity ; Serine