No abstract available.
Humans ; Kidney Failure, Chronic*

This study examined, among others, the relationship between the use of anticonvulsant and the bone mineral metabolism(measured via DR-XRA and biochemical study) in 46 adult epileptic outpatients who had been on anticonvulsant for more than one year at Seoul Red Cross Hospital. The study finding wet as follows. 1) There was statistically significant difference between index group(i.e. 46 adult epileptic outpatients) and control group(i.e. 46 healthy adults without previous exposure to anticonvulsant) in terms of bone mineral density. Specifically, the bone mineral density in the epileptic outpatients was significantly lower than that in the healthy adult. Although there was no statistically significant difference between male and female outpatients, their bone mineral density tended to decrease with the increase of age. 2) The bone mineral density in the epileptic outpatients was negatively correlated to both I) the age when the outpatients stared anticonvulsant treatment and ii) the period for which the outpatients were on anticonvulsant 3) Index group was further classified into three subgroup(i.e. low, normal and high subgroup) based on the mean and standard deviation of the bone mineral density in healthy adults control group. 24 outpatients(52.5%) out of 46 fell into low subgroup, of which 10 were male. Overall, there was no statistically significant difference between male and female outpatients in terms of their bone mineral density. 4) Low subgroup's average age(38.6 with SD of 12.5) was significantly higher than those of the other two subgroup. Low subgroup stained anticonvulsant treated when their average age was 24.8(SD 15.0) years, which was higher than those of the other two subgroups. Low subgroup was on anticonvulsant, on average, far 13.3(SD 7.6) years, which was also higher than those of the other two subgroups although there was no significant difference among the subgroups. 5) A series of comparison regarding the possible impact of various types of anticonvulsan(e.g. PHT, CBZ, FB, SV) in terms of i) overall dosage and ii) daily average dosage on bone mineral density showed no significant difference across the three subgroups. 6) There was no significant difference in terms of bone mineral density between the epileptic outpatients on only one type of anticonvulsant and those on two or more types of anticonvulsant. 7) A biochemical study showed that i) each subgroup fell into normal range in terms of blood serum Ca, F, and ALF with no significant difference among the subgroups, and ii) in low subgroup, there were 6 outpatients(25%) with Ca decrease, 2(9.5%) with P decrease, and 5(20.8%) with ALF increase.
Adult ; Bone Density ; Female ; Humans ; Male ; Outpatients* ; Radiography* ; Red Cross ; Reference Values ; Seoul ; Serum

The authors report two cases of clozapine-induced acute hepatitis. Two patients developed asymptomatic hepatitis and got better with conservative care. We decreased the dosage of clozapine and added hepatic protectors, resulting in normalized laboratory findings. The authors also reviewed side effects of clozapine in this report. We reviewed the suggested mechanism of either clozapine or chlorpromazine-induced hepatitis. Clozapine influences the liver cell via cytochrome P 450 and chlorpromazine does so via mild cholestasis. There may be a possibility that a patient who has experienced drug-induced hepatitis is vulnerable to clozapine-induced acute hepatitis. In this respect, those who have experienced drug-induced hepatitis must be observed more closely.
Chlorpromazine ; Cholestasis ; Clozapine ; Cytochrome P-450 Enzyme System ; Drug-Induced Liver Injury ; Hepatitis* ; Humans ; Liver

OBJECTIVES: Schizophrenic patients have been reported to be associated with abnormal performance on a broad range of neuropsychological tests. But it has been a persistent controversy in the neuropsychology of schizophrenia whether this disorder is characterized by generalized deficits or specific deficits. The purpose of this study was to investigate, using standardized Benton Neuropsychological Assessment(BNA), whether the specific pattern of neurocognitive deficits is found in schizophrenics. METHODS: The subjects were composed of (1) 30 schizophrenic inpatients who were diagnosed as paranoid subtype according to DSM-IV diagnostic criterior and (2) 30 normal subjects with matching demographic variables(i.e. age, sex, educational level). All tests of BNA were given to schizophrenic patients and normal subjects, and the performances of schizophrenic patients and normal subjects were compared on all aspects of BNA. Schizophrenic symptoms were assessed via Positive and Negative Syndrome Scale(PANSS) to determine the relationship between clinical symptoms and schizophrenic cognitive deficits. RESULTS: Of 12 tests of BNA, schizophrenic patients' performances on Serial Digit Learning(SDL), Facial Recognition Test(FR), Tactile Form Perception(TFP), Finger Localization(FL) were significantly lower than those of normal subjects. In addition, schizophrenic patients showed significantly lower performances than those of normal subjects on Right Hand, Left Hand, Identification of two simultaneously touched fingers of FL, and more Peripheral Error on Visual Form Perception Test(VFPT). Finally, no significant correlation was found with respect to the relationships between total scores, positive symptom scores, negative symptom scores of PANSS, and all scores of BNA tests in schizophrenic patients. CONCLUSION: These results suggest that schizophrenic patients may have a specific pattern of neurocognitive deficits in verbal working memory, learning, attention, and complex sensory information processing in visual and haptic modality such as facial perception skills, tactile information processing, independent of psychotic symptoms. The pattern of deifcits is at least in partial, in agreement with many previous study results. On the tests of linguistic functions, visuospatial perception, and constructional abilities, schizophrenic patients' performances were not significantly different from those of normal subjects. The findings on visuospatial perception and constructional abilities imply that some posterior cortical zones may be relatively uncompromised in schizophrenia. Both poor performances on object recognition tests relative to normal performances on object location tests and verbal working memory dysfunction may be associated with the putative dysfunction of the reciprocal connections either (1) between the prefrontal and parietal cortex or (2) between the prefrontal cortex and hippocampal formation. This tentative explanation remains to be confirmed.
Automatic Data Processing ; Diagnostic and Statistical Manual of Mental Disorders ; Fingers ; Form Perception ; Hand ; Hippocampus ; Humans ; Inpatients ; Learning ; Linguistics ; Memory, Short-Term ; Neuropsychological Tests ; Neuropsychology ; Prefrontal Cortex ; Rabeprazole ; Schizophrenia*

Chronic subdural hematoma (CSDH) is a common and relatively benign disease. The aim of this study was to investigate the differences between unilateral and bilateral chronic subdural hematoma in terms of predisposing factors. A retrospective analysis was made of all patients who underwent operation for CSDH at our institution between January 2010 and December 2015. Patients were divided into two groups (unilateral versus bilateral CSDH) and univariate and multivariate analysis was performed to assess demographic data, symptoms, cause of SDH, medical history, laboratory data, and initial radiologic findings. A total of 246 patients were enrolled. There were 63 (25.6%) patients with bilateral CSDH. There were no significant differences concerning sex and initial symptoms between the two groups. Only malignancy history was a significant risk factor for bilateral CSDH in both univariate and multivariate analysis (p = 0.002 and 0.001, respectively). In multivariate analysis, diabetes mellitus (OR 2.03, 95% CI: 1.05 - 3.92, p = 0.0350), malignancy (OR 5.09, 95% CI: 1.93 - 13.40, p= 0.0010), membrane septation (OR 0.50, 95% CI: 0.25 - 0.96, p = 0.0392), and brain atrophy (mild: OR 2.34, 95% CI: 1.16 - 4.71, p = 0.0164, moderate: OR 3.85, 95% CI: 1.32-11.18, p = 0.0131) were significantly associated with bilateral CSDH. The present study suggests that diabetes mellitus, malignancy, membrane septation and mild to moderate brain atrophy is independent predisposing factors of bilateral CSDH.

OBJECTIVE: Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). METHODS: In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3. RESULTS: Mean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027). CONCLUSION: In our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.
Basilar Artery* ; Cerebral Infarction ; Humans ; Mortality ; National Institutes of Health (U.S.) ; Stents* ; Stroke ; Thrombectomy*

OBJECTIVE: To investigate the factors affecting prognosis of extracorporeal shockwave therapy (ESWT) for chronic refractory Achilles tendinopathy (AT). METHODS: Thirty-six patients (48 consecutive feet) with chronic AT (>6 months) and who underwent ESWT for ‘poor’ or ‘fair’ grade in Roles-Maudsley Score (RMS) after unsuccessful conservative treatment were included in the present study. A maximum of 12 sessions of ESWT were conducted until treatment success: RMS reached ‘good’ or ‘excellent’. Termination of ESWT for no response, or ‘poor’ or ‘fair’ grade was regarded as treatment failure. Immediate outcome, long-term outcome (telephone interview after mean 26 months), and factors affecting treatment success were analyzed. RESULTS: Numeric Rating Scale was significantly decreased at immediate and long-term follow-up. Success rate was 71.1% and 90.3%, respectively. Univariate logistic regression identified that immediate treatment success was associated with retrocalcaneal enthesophyte on X-ray (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01–0.28), pretreatment abnormal ultrasonography echogenicity within Achilles tendon (OR, 18.89; 95% CI, 2.08–171.96), mean duration of ‘post-treatment soreness’ (OR, 0.55; 95% CI, 0.33–0.94), and duration of ‘post-treatment soreness after first ESWT’ (OR, 0.06; 95% CI, 0.01–0.34). The duration of ‘post-treatment soreness after first ESWT’ was found to be the only factor associated with long-term success (OR, 0.32; 95% CI, 0.10–0.99). CONCLUSION: ESWT appears to be effective in achieving long-term success in chronic refractory AT. Immediate success was associated with absence of retrocalcaneal enthesophyte on X-ray, presence of pretreatment abnormal ultrasonography echogenicity, shorter mean duration of ‘post-treatment soreness’, and shorter duration of ‘post-treatment soreness after first ESWT’. The shorter duration of ‘post-treatment soreness after first ESWT’ was identified as the only positive prognostic parameter in achieving long-term success.
Achilles Tendon ; Follow-Up Studies ; High-Energy Shock Waves ; Humans ; Logistic Models ; Prognosis* ; Tendinopathy* ; Treatment Failure ; Treatment Outcome ; Ultrasonography

OBJECTIVE: To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia. METHODS: Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined. RESULTS: VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia. CONCLUSION: We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.
Deglutition Disorders* ; Deglutition* ; Diagnosis ; Esophageal Sphincter, Upper ; Healthy Volunteers* ; Humans ; Manometry* ; Pharynx ; Relaxation ; ROC Curve ; Sensitivity and Specificity ; Tongue

OBJECTIVES: This study was designed to examine the effect of marital satisfaction and dysfunctional attitudes on depression in married women. METHODS: Forty depressed married female patients and 34 non-depressed married women as normal control group completed three self-report questionnaires, Beck Depression Inventory(BDI) Dysfunctional Attitude Scale(DAS) and Dyadic Adjustment Scale(DYAS) Marital satisfaction and dysfunctional attitudes were compared by student t-test between the two groups. Also, relative importances of each variables to depression were examined with stepwise multiple regression analysis. RESULTS: Depressed patients reported significantly lower level of marital satisfaction and showed higher level of dysfunctional attitudes than normal controls. Dyadic satisfaction, approval need, and perfectionism subfactors were more important in predicting depressive symptomatology than other variables in patients. CONCLUSION: We conclude that marital satisfaction has significant influence on development and maintenance of depression in married women, and in underlying thinking process, dysfunctional attitudes serve as a cognitive vulnerability factor. This conclusion involves the expectation that if dysfunctional attitudes of depressed married women could be changed positively, their marital satisfaction will be increased to higher level and depression will be decreased. Overall, our findings stress that we need to consider the degrees of marital satisfaction and dysfunctional attitudes of depressed maried women, when treating them, in order to individualize treatments and optimize our ability to predict responsiveness to therapy.
Depression* ; Female ; Humans ; Surveys and Questionnaires ; Thinking

BACKGROUND: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. METHODS: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A - L), OC by surgeon A (A - O) and OC by surgeon B (B - O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L - N) with NAC infusion (L + N), open colectomy (O - N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. RESULTS: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A-L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O-N group. NAC offered no added benefits to the L + N and L-N groups. CONCLUSIONS: NAC offered faster recovery in the OC group but not in the LC group.
Colectomy ; Colorectal Neoplasms ; Colorectal Surgery* ; Humans ; Intubation ; Laparoscopy ; Laparotomy ; Oxidative Stress ; Prospective Studies ; Retrospective Studies