OBJECTIVES: There have been growing interests about alopecia occured during childhood and adolescence in clinical practice. The purpose of this paper is to explore the clinical characteristics of early onset alopecia in order to establish effective psychiatric intervention strategy. METHODS: The subjects were 31 early onset alopecia patients(14 males, 17 females) and 62 late onset control patients(26 males, 36 females). These patients had visited psychiatric outpatient clinic consulted from the department of dermatology, Yongsan hopital, Chung Ang University, Seoul, Korea, from January 1998 to june 1999. The sociodemographic data, clinical pattern of alopecia, psychiatic characteristics, comorbid physical illnesses and treatment variables were assesed. The data was statistically analyzed using chi-squre test and t-test through SPSSWIN 9.0V. RESULTS: 1) Early onset alopecia patients were more likely born in autum, had fewer siblings, and showed higher economical level of both patient and their parents than late onset patients. 2) Early onset alopecia patients were more likely to show diffuse hair loss, had more experienced past history of alopecia, more frequently had recurrence more than 3 times, were more severely damaged, had longer duration of hair loss had more loss of hairs on the vertex area at onset of alopecia, had more loss of hairs more than 2 areas, and had poorer prognosis such as no change or exacerbation in spite of treatment, spontaneous withdrawal of tratment and lack of efficacy to treatment than late onset patients. 3) Early onset alopecia patients were poorer in their adjustment in family life, or interpersonal relations, and more suffered from school stress such as changes of school life or test stress related with school entrance examination than late onset patients. 4) Early onset alopecia patients were more likely to show serious psychopathology such as increased rate of the anxiety disorders, of anxiety symptoms or depressive symptoms, and of personality disorders including the histrionic or the passive traits than late onset patients. 5) Early onset alopecia patients were more likely showed dermatitis including seborrheic dermatitis, and more significantly responding to the treatment with anti-anxiety drug, such as alprazolam, and dermatological therapies including polytar or tretinin than late onset patients. CONCLULSION: These findings suggest that dermatologists, as primary care physicians, are in unique position to recognize psychiatric comorbidity and to execute earlier intervention, in collaboration with psychiatrists, of early onset alopecia patients.
Adolescent* ; Alopecia* ; Alprazolam ; Ambulatory Care Facilities ; Anxiety ; Anxiety Disorders ; Comorbidity ; Cooperative Behavior ; Depression ; Dermatitis ; Dermatitis, Seborrheic ; Dermatology ; Equidae ; Hair ; Humans ; Interpersonal Relations ; Korea ; Male ; Parents ; Personality Disorders ; Physicians, Primary Care ; Prognosis ; Psychiatry ; Psychopathology ; Recurrence ; Seoul ; Siblings

OBJECTIVES: The present study was performed to reveal correlations between the severity of the alopecia and their alopecia related variables such as patterns of hair loss, psychiatric characteristics, associate illnesses, and methods of treatment and to use them as basic materials for proper manaement and early prevention of the alopecia prone cases. METHODS: In order to analyze correlation between the severity of psychopathogy and the severity of hair losses, the subjects were divided into two subgroups as the 60 case of alopecia areata and the 33 cases of alopecia totalis with more severely affected loss of hairs, who had visited to the department of psychiatry after they were consulted from the department of dermatology, Yongsan hopital, ChungAng University, Seoul, Korea, from January 1998 to December 1998. In data analysis, the subjects were statistically assesed by chi-squre test and T-test through SPSS-PC+ 8.0V. RESULTS: 1) Those with the more severely affected alopecia were more likely to visit to the department of dermatology in winter, and to show lower socioeconomical level in comparison to the alopecia areata. 2) Those with the more severely affected alopecia were more likely to show past history of alopecia, to recur frequently more than 3 times, to be damaged more severely, to have an younger mean age at onset of alopecia, to have longer total duration of hair loss than 2 years, to have longer recent duration of hair loss than 9 months, to have more loss of hairs on the vertex area at onset of alopecia, to have more loss of hairs in eyebrows, to have more loss of hairs more than 2 areas, to have more family history of alopecia in their parent, and to have poorer prognosis in comparison to those of the alopecia areata. 3) Psychosocial stress were positively correlated with the severity of loss of hairs. In the more severely affected alopecia group, their degree of stress were perceived higher. The more severely affected patients with alopecia , were poorer in their adjustment in family life,interpersonal relations or heterosexual relations, and suffered more from intrafamilial life changes in comparison to those of the alopecia areata group. 4) Those with the more severly affected alopecia were more likely to show serious psychopathology such as an increased rate of the depression, to complain more frequently with anxiety symptoms or depressive symptoms, to have personality disorders including the histrionic or the passive aggressive traits in comparison to the alopecia areata. 5) Those with the more severly affected alopecia were more likely to show neurotic MMPI code profiles such as histrionic or hypochondriacal trends. 6) Antianxiety drug such as alprazolam and drug therapies including tretinin,polytar or oral sorarens plus ultra-violet light A photochemotherapy were significantly more effective in the treatment of those with the more severly affected alopecia group. CONCLUSION: The most important factors in developing a psychopathologic reaction to the hair loss due to alopecia seems to be the presence of mental disorders including depression, the presence of stressful life events such as intrafamilial life changes, the presence of a significantly higher percentages of personality disorders such as the hysterical or the passive aggressive, and the presence of the psychosocial sequele and maladjustment in various life situations. From the above facts, the authors suggested that dermatologists acting as the primary care physician are in a unique position to recognize psychiatric comorbidity and execute meaningful intervention for patients with alopecia with psychiatrists.
Alopecia Areata* ; Alopecia* ; Alprazolam ; Anxiety ; Climacteric ; Comorbidity ; Depression ; Dermatology ; Drug Therapy ; Equidae ; Eyebrows ; Hair ; Heterosexuality ; Humans ; Korea ; Mental Disorders ; MMPI ; Parents ; Personality Disorders ; Photochemotherapy ; Physicians, Primary Care ; Prognosis ; Psychiatry ; Psychopathology ; Seoul ; Statistics as Topic

OBJECTIVES: The present study was performed to identify the socio-psychiatric aspects of adolescent criminal offences reported on daily newspapers and to use them as basic materials for prevention of adolescent criminal offences. METHODS: The author analysed 681 cases of adolescent criminal offenders, including 642 males and 39 females who reported on daily newspaper such as DongA Ilbo and Chung-Cheong Ilbo, aged from 12 through 21. In data analysis, the subjects were divided into two subgroups as the student(261 cases) and the non-student(420 cases). RESULTS: 1) The rate of student were more common in female and younger in their age group comparing with the non-student. Recently, the incidence of student's offences of all adolescent of offences were remarkably increased, while those of the non-student was Decreased. 2) Violence and theft or group offences were more common in the student, while felony or solitary offences were more frequently observed in the non-student. The more vulnerable time of criminal offences in the student were more in afternoon, while the non-student were more in midnight. 3) The psychological conflicts and the economical causes were the most ones in the student, while the curiosity, the personality problems and the heterosexual conflicts were more common in the lion-student. physical aggressions were more prominent ones in the student, compared with the instrumental aggression in the non-student. 4) The student committed offense more in the patterns of group offences with peers, younger in their age and were more often with their peer students, while the non-student committed offense more in the patterns of solitary crime, more prevalent with older aged jobless peers. 5) Most of the victims in the student were more abused to the intimate persons, and more younger students, while those in the non-student were more abused to the unknown persons and more older aged adolescents. CONCLUSION: In order to prevent and correct increasing trends of violence in school, nationwide guidance programs should be promptly applied through promotion of psychological wellbeing in family and school, proper guidance to peer relationship, and providing more opportunities for sound recreational activities in evening time to help dissipate the frustration of the adolescents.
Adolescent* ; Aggression ; Crime ; Criminals* ; Exploratory Behavior ; Female ; Frustration ; Heterosexuality ; Humans ; Incidence ; Korea* ; Male ; Periodicals* ; Statistics as Topic ; Theft ; Violence

BACKGROUND: We performed electrical cardioversion for the patients with chormic nonvalvular atrial fibrillation under the transesophageal echocardiographic guidance after anticoagulation to evaluate the safety of this procedure and the effects of electrical cardioversion on the atrial function. METHODS: After anticoagulation therapy with coumadine for three weeks, we tried chemical cardioversion with amiodarone first. Failed cases were included in this study. Pre-cardioversion transesophageal echocardiographic parameters were measured after exclusion of thrombi. After sedation with intravenous midazolam, direct-current cardioversion was done with the transesophageal echocardiographic probe in situ. Immediately after sinus conversion, we measured echocardiographic parameters again. Spontaneous echo contrast(SEC), left atrial appendage flow velocity, pulmonary vein flow velocity and time-velocity-integral(TVI), transmitral flow velocity, TVI and deceleration time were measured. All patients were anticoagulated for at least 4 weeks after cardiovesion. RESULTS: The total number of patients was forty one(24 males, 17 females) with the mean age of 58 years(range : 39-70). Mean duration of atrial fibrillation was 65 months(range : 1-360). Hypertension(12), dilated cardiomyopathy(10), cerebrovascular accidents(6), ischemic heart disease(2) and chronic lung disease(1) were associated. There were no complications. SEC increased or newly appeared in 18(43.9%) patients after sinus conversion. The left atrial appendage emptying velocity decreased(32.8+/-17.4 vs. 22.1+/-11.4cm/sec, p=0.020) and systolic TVI of both upper pulmonic vein increased significantly after sinus conversion. In two cases, early systolic forward flow(S1) of pulmonic vein appeared after sinus conversion. Transmitral E velocity decreased(86.9+/-28.8 vs. 76.3+/-30.6cm/sec, p=0.006) and the deceleration time increased(164+/-49 vs. 206+/-53msec, p=0.000) after sinus conversion. Transmitral A velocity was still low(34.9+/-19.5cm/sec) and E/A ratio was high(2.6+/-1.4) immediately after sinus conversion. CONCLUSION: After appropriate anticoagulation therapy and exclusion of left atrium and left atrial appindage thrombi with TEE we could perform electrical cardioversion safety without complications. The changes in transesophageal echocardiographic parameters after sinus conversion revealed the appearance of atrial mechanical activity in concordance with electrical activity. But these findings suggested atrial stunning or electromechanical dissociation which necessitates extended anticoagulation therapy until the full recovery of atrial mechanical function.
Amiodarone ; Atrial Appendage ; Atrial Fibrillation* ; Atrial Function ; Deceleration ; Echocardiography* ; Echocardiography, Transesophageal ; Electric Countershock* ; Heart ; Heart Atria ; Humans ; Lung ; Male ; Midazolam ; Pulmonary Veins ; Veins ; Warfarin

Biofeedback is the treatment of choice for functional defecation disorders such as idiopathic chronic constipation and neurogenic fecal incontinence. The pre-existing biofeedback systems have many disadvantages. The aims of current project are, first, to develop the biofeedback system into the application software in the Windows environment, and, second, to assess the possibility of clinical usage for patients with functional defecation disorders. The hardware and software of the BASCO (Biofeedback Anal Sphincter Control) system were based on the signal measurement and signal processing of anal sphincter EMG (Electromyography). BASCO system was applied to 5 normal healthy controls and 20 patients with functional defecation disorders. Patients group was categorized as constipation group (N1=15) and incontinence group (N2=5). With use of current system, EMG-based biofeedback therapy was performed, and the outcome was analysed. Anal EMG signal data was processed by the software, and displayed in the monitor of personal computer. The software of EMG-display and database management were adequately operated. In N1 group, a paradoxical elevation or equalized activity of anal EMG pattern was shown in the simulated defecation. In N2 group, low electrical activity was shown. These findings were used for the EMG-based biofeedback therapy as a pilot study. The clinical symptoms were improved in 12 of N1 group and 3 of N2 group in the period of 3.7 (range, 1~12) months follow-up. In Conclusion, newly-developed BASCO system was adequately operated in the volunteer and patients groups. The multi-tasking and multi-processing functions were adequately shown in the real time. Current results could be used for clinical appraisal. Specifically, this system could be used for the practical application of biofeedback therapy in the patients with chronic constipation or fecal incontinence.
Anal Canal* ; Biofeedback, Psychology* ; Constipation ; Defecation* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Microcomputers ; Pilot Projects ; Volunteers

The goal of this study was to investigate the incidence of third head of biceps brachii (THBB) for understanding unexpected cases in clinical practice. The sample consisted of 214 upper extremities from 107 adult cadavers donated to science (70 males and 37 females; age, 51-87 years). Cases with pathological changes or trauma to the upper limbs were excluded. THBB was found in 14 of the 214 upper extremities. The incidence of variation was approximately 6.5%. THBB was found in 10 male limbs and 4 female limbs, and none of the cases was bilateral. THBB was a flat muscular belly-like structure that originated from the anteromedial surface of the humerus between the insertion of the coracobrachialis and the origin of the brachialis. This finding may be clinically important because the musculocutaneous nerve is subjected to compression by the bulky third head.
Adult ; Cadaver ; Extremities ; Female ; Head ; Humans ; Humerus ; Incidence ; Male ; Muscles ; Musculocutaneous Nerve ; Upper Extremity

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Aged ; Clinical Coding ; Critical Care* ; Diffusion ; Disease Outbreaks ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Hand ; Humans ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Male ; Methods ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Sputum

We followed up the 100 patients (104 eyes) who had undergone cataract extraction and PCL implantation into the bag with 3M diffractive multifocal intraocular lensee for at least 2 month, in order to evaluate the function of this lens. 92 eyes (88.5%) had the far corrected vision more than 0.5 and 94 eyes (90.4%) had the near vision with far correction more than J3. We added additional adds (-0.25, +0.25, +0.50, +0.75D) in order to ascertain the adequacy of +3.50D add in this lens and it was found that the additional add of +0.75D was most preferred. This means that more add is necessary for near vision. There was, also, no more remarkable side effects or difficulties associated with this lenses. So, multifocal Intraocular lenses enable good near vision without any severe disadvatages but the amount of near add is cuntroversial.
Cataract Extraction ; Humans ; Lenses, Intraocular*

Neurilemmoma is the most frequent solitary tumor of the peripheral nerves. It is a tumor from Schwann cells, and it is usually solitary and benign. Treatment of this benign lesion is usually by excisional biopsy. This report concerns a rare case of neurilemmoma developed in the penis in a 51 years old male and the relevant literature has been reviewed.
Biopsy ; Humans ; Male ; Middle Aged ; Neurilemmoma* ; Penis* ; Peripheral Nerves ; Schwann Cells

PURPOSE: Aims to analyze the occlusal wear patterns in maxillary posterior teeth with palatal side abfractions and study the association between occlusal force and abfractions. MATERIALS AND METHODS: This study was conducted in a total of 308 teeth from 148 patients with palatal side abfractions in maxillary posterior teeth. The occlusal wears in maxillary premolars and molars with palatal side abfractions were classified and recorded. The classification was done by type of teeth, age, and gender, and in order to evaluate the statistical significance between groups, chi-square test was conducted (α = 0.05). RESULTS: Palatal side abfractions in maxillary posterior teeth were observed at the highest frequency in the 1st molars, and in all teeth with palatal side abfractions, more than one occlusal wear was observed. In classification by type of teeth, by age, and by gender, the occlusal wears in teeth with palatal side abfractions were observed at high frequency in cuspal inclined plane, central fossa, and marginal ridge, and there was a statistical significance (P < 0.05). CONCLUSION: Palatal side abfractions were observed at the highest frequency in maxillary 1st molars, and in all maxillary posterior teeth where palatal side abfractions were found, the occlusal wears were observed. And the occlusal wears were observed at high frequency in cuspal inclined plane, central fossa and marginal ridge. Such results show that abfraction is associated with occlusal force.
Bicuspid ; Bite Force ; Classification ; Humans ; Molar ; Tooth Attrition ; Tooth Fractures ; Tooth