Hemolytic uremic syndrome is characterized by a triad of clinical findings including microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The precise etiology and pathogenesis of hemolytic uremic syndrome are not established by now. According to clinical reports, hemolytic uremic syndrome is associated with infection(bacteria, virus), connective tissue disease, malignancy, drug and pregnancy. Recently, many investigators have reported that cyclosporine induces hemolytic uremic syndrome. Cyclosporine is one of the immunosuppressants that are essential for kidney transplantation. We experienced one case of hemolytic uremic syndrome that developed after kidney transplantation receiving cyclosporine. A 43-yr-old woman with end-stage renal failure received kidney transplantation from her daughter. After operation, she received cyclosporine for immunosuppression and thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure were developed. She was diagnosed as cyclosporine induced hemolytic uremic syndrome and plasma exchange was started with fresh frozen plasma. The plasma exchange was done 16 times and the clinical symptoms were improved. We present this case with review of literatures.
Acute Kidney Injury ; Anemia, Hemolytic ; Connective Tissue Diseases ; Cyclosporine* ; Female ; Hemolytic-Uremic Syndrome* ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Nuclear Family ; Plasma Exchange* ; Plasma* ; Pregnancy ; Research Personnel ; Thrombocytopenia

BACKGROUND: Sodium citrate has been used as a coagulation test because factor V and VIII are more stable in a citrated specimen. Ethylenediaminetetraacetic acid (EDTA) has been used for the hematologic test because blood cells are preserved better in the EDTA specimen. Both sodium cit-rate and EDTA have the same principle of anticoagulation. They bind free plasma calcium to pre-vent clotting. This study was performed to see if we could substitute EDTA for sodium citrate in pro-thrombin time. METHODS: Blood samples from 133 patients who underwent the prothrombin time test in our hos-pital and 36 healthy controls were used. Each sample was anticoagulated with both sodium citrate and EDTA. We examined the prothrombin time with citrated specimen and EDTA specimen using the Owren reagent; Nycotest PT and also the Quick reagent; and the IL Test PT-Fibrinogen HS. RESULTS: The mean prothrombin time with EDTA specimen was longer than that with the citrated specimen by the Quick method but was shorter using the Owren method. In the Owren method, there was a significant correlation between mean prothrombin time with the citrated and EDTA spec-imen but not using the Quick method. CONCLUSIONS: The prothrombin time with the citrated and EDTA specimens correlated with each other by the Owren method. This correlation could make it possible to replace sodium citrate with EDTA.
Blood Cells ; Calcium ; Citric Acid ; Edetic Acid* ; Factor V ; Hematologic Tests ; Humans ; Plasma ; Prothrombin Time* ; Prothrombin* ; Sodium

Under new mental health and welfare law, involuntary admission is allowed only for persons with mental illness based on the narrowed criteria of mental illness when they meet both need for treatment and danger to themselves and others. These stringent danger criteria along with narrowed definition of mental illness may prevent timely intervention for people with acute psychosis. It is claimed that the danger criteria is essential to keep up with international (UN, WHO) principles for legislation of mental health acts and laws of advanced countries. The international principles, however, do not necessarily call for stringent danger criteria for involuntary hospitalization. Danger criteria are not also prerequisites for involuntary hospitalization in many advanced countries. In countries with strict danger criteria, complementary measures seem to be taken for the drawback of danger criteria. As for the involuntary hospitalization by legal guardians, the complicated qualification for legal guardians may hinder prompt admission. The required number of legal guardians also needs to be changed from two to one person. Even in the situation where involuntary hospitalization is deemed urgent, there is no way to transport the patients to the hospital for assessment or temporary admission unless the police judges the patients to be dangerous to themselves or others. Outpatient treatment order can be an alternative to involuntary admission. However, it is rarely used since the order cannot be applied to those who do not have history of admission due to danger. For voluntary admission, status conversion to involuntary admission needs to be allowed in case of aggravation of symptoms to meet involuntary admission criteria. In addition, informal admission needs to be introduced to avoid unnecessary formal procedures for patients admitting voluntarily to open ward. In view of all these issues with new mental health and welfare law, entire revision of new mental health law is urgent to balance the rights to proper treatments and protection of human rights of persons with mental disorder.
Evaluation Studies as Topic* ; Hospitalization* ; Human Rights ; Humans ; Jurisprudence* ; Korea* ; Legal Guardians ; Mental Disorders ; Mental Health* ; Outpatients ; Patient Admission ; Police ; Psychotic Disorders

Two cases of an anomalous systemic arterial supply to the basal segments of the left lower lobe without pulmonary wequestration are presented. In the first case, a preoperative diagnosis was made by chest CT, and confirmed by angiograpy, in a 22-year old man who had a recurrent hemoptysis. There was systemic arterial supply that originated from the thoracic descending aorta and no pulmonary arterial supply to the basilar segment of the left lower lobe. However, the pulmonary parenchyma was normal without sequestration. Ligation of the abnormal artery and a left lower lobectomy were performed without complication. In the second case, there were characteristic features of this anomaly on chest CT and the angiogram in a 31-year-old man with symptoms of hemoptysis. The patient refused surgery.
Adult ; Aorta, Thoracic ; Arteries ; Bronchopulmonary Sequestration ; Diagnosis ; Hemoptysis ; Humans ; Ligation ; Tomography, X-Ray Computed

Kleine-Levin syndrome is a rare disorder which usually affects adolescent males and is characterized by periodic hypersomnia, hyperphagia and abnormal behavior. This is an unexplained clinical syndrome for which several etiologies have been entertained with no standard treatment is yet available. A 18-year old woman began suffering from recurrent hypersomnia, hyperphagia, and behavioral disturbances such as irritability, derealization, and amnesia. She was normal between the episodes and diagnosed as Kleine-Levin syndrome. In the course of about two years she had 11 episodes and the mean interval between the episodes was 52.8+/-16.7 days. After application of amantadine, there were two mild episodes and then she had no episodes for more than 6 months. This case suggests the possible role of amantadine in the treatment of Kleine-Levin syndrome.
Adolescent ; Amantadine* ; Amnesia ; Depersonalization ; Disorders of Excessive Somnolence ; Female* ; Humans ; Hyperphagia ; Kleine-Levin Syndrome* ; Male

OBJECTIVE: As homeless people increased in urban areas after the economic crisis in Korea, they became a serious social problem. Foreign research showed that many homeless people had chronic mental illnesses which were closely related with the cause and prognosis of homelessness. But very little was known about the prevalence of mental disorders in Korean homeless people. This study tried to capture the overall picture of mental disorders in homeless people. METHOD: The study subjects were 216 homeless people who stayed at two Pusan shelters between late 1998 and early 1999. Questionnaires on sociodemographic data were administered to the subjects, and then diagnoses of major DSM-IV Axis I mental disorders were made using Structured Clinical Interview for DSM-IV Axis I Disorders(SCID). The lifetime and current prevalence of mental disorders in this study were compared to those from other studies in Korean general population and in foreign homeless people. RESULTS: The lifetime prevalence of major DSM-IV mental disorders(mood disorders, psychotic disorders, and substance use disorders) of 216 homeless people was 60.1%, and current prevalence was 35.7%. The lifetime prevalence of major depressive disorders was 22.5% which was higher than that of foreign studies. The lifetime prevalence of alcohol use disorder was 47.4%. The lifetime prevalence of psychotic disorders was 3.8%, and among them the lifetime prevalence of schizophrenia was 1.9% which was lower than that of foreign studies. CONCLUSIONS: In Korean homeless people, mood disorders and substance use disorders were the main mental disorders and psychotic disorders such as schizophrenia were less than in foreign homeless people. The plans to approach and treat homeless people with mental disorders should be made.
Axis, Cervical Vertebra ; Busan ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Epidemiologic Studies* ; Homeless Persons ; Humans ; Korea ; Mental Disorders* ; Mood Disorders ; Prevalence ; Prognosis ; Psychotic Disorders ; Surveys and Questionnaires ; Schizophrenia ; Social Problems ; Substance-Related Disorders

OBJECTIVES: The current Korean Mental Health Act (KMHA) indicates that a patient, who voluntarily gave their permission for admission into a mental health facility, has the right to be discharged upon personal request. However, there is no clause in the KMHA that allows a change in a patient's voluntary status under special circumstances. The purpose of this study was to investigate problems that may arise from the lack of such a clause ; problems that can result in misinterpretation and lead to the prohibition of voluntary admission status conversion. METHODS: Previous cases presented to the National Human Rights Commission of Korea were investigated in order to determine the current state in Korean psychiatric practice regarding the conversion from voluntary to involuntary admission status. In addition, examples of similar mental health legislation in use by the United Nations (UN), World Health Organization (WHO), and several advanced countries pertaining to such conversions were investigated. These examples were used as models for making recommendations for possible changes to the KMHA. RESULTS: From 2010 to 2014, more than 220 petitions were filed with the National Human Right Commission of Korea. The petitions involved voluntarily institutionalized patients who had their requests for discharge rejected. Based on mental health regulations of the UN, WHO, and such countries as the United States, England, Canada, Australia, and Japan, the KMHA should include a provision that, upon receiving a discharge request, allows for discharge refusal if the voluntarily admitted patient is considered not mentally fit. CONCLUSION: The results suggest that the absence of a regulation allowing admission status conversion in the current KMHA is inappropriate. Rectification of this absence is urgently needed.
Australia ; Canada ; England ; Human Rights ; Humans ; Japan ; Korea ; Mental Health ; Patient Admission ; Social Control, Formal ; United Nations ; United States ; World Health Organization

The new Mental Health and Welfare Law in Korea was revised to require additional diagnosis by a psychiatrist from another public or designated hospital for involuntary admission beyond 2 weeks. In addition, it features the newly established Admission Review Committee for better protection of human rights. The provision of the additional diagnosis by an external psychiatrist resulted from misinformation about the distinction between the second opinion for medical assessment and the review of admission by independent authorities. An additional diagnosis is not required by an external doctor since it is not for review of adequacy of admission but just for second opinion for better medical assessment. Given the limited number of qualified public hospital psychiatrists, additional diagnosis by external psychiatrists does not seem practical unless private hospital doctors are required to visit neighboring hospitals. The current method of cross checking between neighboring doctors is not in accordance with the principles that review should be done by independent authorities. The Admission Review Committee also does not seem to serve the purpose since the role of the Committee is limited to document review, while the proper role of the Committee is left to individual doctors. Admission review should be performed through a thorough interview with the patient by a judicial (or quasi-judicial) authority. Law revision is urgently needed to ensure proper judicial (or quasi-judicial) review of admission, and to streamline unnecessary procedures such as the additional diagnosis by external doctors.
Advisory Committees* ; Diagnosis* ; Hospitals, Private ; Hospitals, Public ; Human Rights ; Humans ; Jurisprudence* ; Korea* ; Mental Health* ; Methods ; Psychiatry* ; Referral and Consultation ; Unnecessary Procedures

No abstract available.
Diagnosis* ; Polymerase Chain Reaction* ; Scrub Typhus*

BACKGROUND: We describe a case of scrub typhus, of which the diagnosis was made by PCR using eschar and serologic diagnosis. The patient's attendant insisted that the eschar like crust lesion was caused by minor trauma. In order to find out whether the crust on his head is eschar or not, PCR using eschar was performed. MATERIALS AND METHODS: Informed consent was taken, and then a piece of crust was taken apart. We immerged the crust with about 1 mL of saline bottle. We performed the nested PCR of gene that encodes the 56-kDa specific protein for O. tsutsugamushi. The first serology test for O. tsutsugamushi using indirect immunofluorescent antibody was performed. Then the second serology test & eschar PCR assay were performed at the second week after treatment. RESULTS: 56-kDa protein specific bands were detected in both buffy coat and eschar sample collected at first day of antibiotic administration. However, in the follow up PCR study 7 days after antibiotics administration, 56-kDa protein specific band was detected at only newly formed eschar, not at buffy coat. CONCLUSION: The eschar PCR assay can be useful diagnostic test, even though patient with scrub typhus underwent appropriate antibiotics therapy. The nested PCR method for eschar might be both rapid diagnostic test for scrub typhus in the early acute stage and differential test whether a crust is eschar or not.
Anti-Bacterial Agents ; Diagnosis* ; Diagnostic Tests, Routine ; Follow-Up Studies ; Head ; Humans ; Informed Consent ; Polymerase Chain Reaction* ; Scrub Typhus*