Cough is one of the most common symptoms leading to referral to medical institutions, and can be triggered by various causes. Since chronic cough does not respond well to antitussives that are generally prescribed in outpatient clinics, it is most important to seek the underlying cause and provide appropriate treatment rather than to just simply relieve symptoms. Although chronic cough is induced by various causes, it is one of difficult symptoms to deal with in clinical settings, having no specific symptom for diagnosis or definitive diagnostic tool. While taking patient's history, however, physicians can take a step closer to the treatment of chronic cough by asking more details about the character, frequency, onset, duration, and aggravating factor of cough, if any; the type of medication and time of its application; the response to previous treatment, etc. Underlying causes of chronic cough often require a long term treatment. Therefore, when treating patients, the physician must inform and discuss with the patient about the duration of treatment and what specifically he or she needs to do at home to maintain satisfactory compliance and expect good outcomes.
Ambulatory Care Facilities ; Antitussive Agents ; Compliance ; Cough ; Gastroesophageal Reflux ; Humans ; Laryngopharyngeal Reflux ; Referral and Consultation

POEMS syndrome is an unusual plasma cell dyscrasia with multisystemie manifestations featuring polyneuropathy, organomegaly, endocrinopsthy, M protein and skin changes. We have seen a 49-year-old woman presenting with hyperpigmentation, hypertrichosis, hyperhidrosis, and taut thickened skin of the extremities as a skin manifestation of this syndrome. We review the literature and report a case.
Extremities ; Female ; Humans ; Hyperhidrosis ; Hyperpigmentation ; Hypertrichosis ; Middle Aged ; Paraproteinemias ; POEMS Syndrome* ; Polyneuropathies ; Skin ; Skin Manifestations

PURPOSE: This study is to determine actor and partner effects of stress coping on quality of life (QoL) of cancer patients and their primary caregivers using an actor-partner independence model (APIM). METHODS: The subjects of this study were adults aged 19 years and over who visited a hospital. They were diagnosed with cancer and were treated with chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. 137 patients with cancer and 137 caregivers were included in the study. RESULTS: Cancer patient stress had a direct effect on their stress coping (β=.42, p=.004). Primary caregiver stress also had a direct effect on their stress coping (β=.41, p < .001). Factors significantly affecting cancer patients' QoL were patient stress (β=−.14, p=.002), stress coping (β=.24, p < .001), and primary caregiver stress coping (β=.11, p=.021). Factors significantly affecting primary caregiver QoL were primary caregiver stress (β=−.22, p < .001) and their stress coping (β=.14, p=.009). CONCLUSION: In order to improve the quality of life of cancer patients and caregivers, it is necessary to consider cancer patients and caregivers as a unit when constructing intervention programs for stress management.
Adult ; Caregivers* ; Drug Therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Quality of Life* ; Radiotherapy

The periodic sharp wave complexes are the most characteristic EEG abnormalities in sCJD. We report the serial EEG findings in a patient with probable sCJD. The initial EEG showed diffuse theta and delta slowings only. However, it changed to the typical periodic sharp wave complexes according to the worsening clinical state. These changes occurred during a short-term interval. The serial EEGs within the short-term interval will be helpful for the earlier diagnosis of sCJD.
Diagnosis ; Electroencephalography* ; Humans

The analysis of heart rate variability is a useful tool to investigate the physiologic phenomena related with autonomic functions. At first, it was developed to evaluate the relation between cardiovascular disease and autonomic balance. Nowadays, the application of it's use has been considered in psychiatric practice. And its convenient usage and non-invasiveness gathered more interest of clinicians and investigators. However, no systematic review of the studies on the heart rate variability in psychiatric field is tound. Thus we reviewed the literatures on the usage and it's limitations of the heart rate variability in terms of the spplication in psychiaric practice and research. Interviews with experts on autonomic functions were also included to supplement the review. Studies found that patients with schizophrenia showed reduced heart rate variability while taking clozapine, and severely depressed patients showed more reduced heart rate variability than normal control. Patients with various anxiety disorders including panic disorder and posttraumatic stress disorder showed eleated sympathetic autonomic tone compared with normal control subjects. However these findings remained controversial because of many confounding factors including drug effects and individual and situational factors affecting heart rate variability. With further studies after successful control of confounding variables, the analysis of heart rate variability would be a useful physiologic parameter of asessing psychiatric patients in clinical practice and research.
Anxiety Disorders ; Cardiovascular Diseases ; Clozapine ; Confounding Factors (Epidemiology) ; Heart Rate* ; Heart* ; Humans ; Panic Disorder ; Research Personnel ; Schizophrenia ; Stress Disorders, Post-Traumatic

Infectious endocarditis is associated with five cutaneous findings: subungal hemorrhages, Roth spots, Osler's nodes, the Janeway lesion and petechiae, which are infrequently reported in the current antibiotic era. The Janeway lesion, first described by Edward Janeway in 1899, is an erythematous or hemorrhagic, non-tender macule or nodule several centimeters in diameter occurring on the palms or soles. We report a case of a Janeway lesion in a 30-year-old woman, who had pruritic nontender macules with fever of unkown origin. Our case demonstrates the importance of careful skin examination in systemic diseases such as infectious endocarditis. The findings of the Janeway lesion in this woman were important in securing the early clinical diagnosis of infectious endocarditis.
Adult ; Diagnosis ; Endocarditis* ; Female ; Fever ; Hemorrhage ; Humans ; Purpura ; Skin

BACKGROUND/AIMS: Due to widespread use of computerized tomography (CT) scan to examine patients with variable disease or complaints, detection of incidental or unsuspected gastrointestinal abnormalities are not uncommon. Clinical significance of incidentally detected bowel wall thickening (BWT) on abdominal CT scan is uncertain at present. Despite the necessity for the clinical guidelines describing the evaluation of incidental bowel wall thickening on CT scan, there have been few studies concerning these radiological abnormalities. Our objective was to determine whether endoscopic evaluation is necessary for the evaluation of these abnormal findings. METHODS: This study evaluated one hundred and forty patients with incidentally detected BWT on abdominal CT scan in Inje University Sanggye Paik Hospital from 2001 to 2003. 102 patients of those were proceeded by endoscopic evaluation. Forty-eight patients had received upper endoscopy, 26 patients had colonoscopy, while 28 patients had sigmoidoscopy. RESULTS: Endoscopic work up revealed significant abnormalities in 83% of patients with incidental findings of the distal esophagus, 73% of patients with thickening of the stomach, 35% of patients with thickening of the right colon, and 71% of patients with thickening of the sigmoid colon and rectum. CONCLUSIONS: Although significant pathologic findings are less common in thickening of the right colon than other bowel wall thickening, all of these incidental findings on CT scan warrant further endoscopic evaluation.
Esophagus/radiography ; Female ; Humans ; Incidental Findings ; Intestines/pathology/*radiography ; Male ; Middle Aged ; *Radiography, Abdominal ; Stomach/radiography ; *Tomography, X-Ray Computed

It is uncommon that Anesthesiologist experience thyroid storm during the elective surgery because of marked reduction of operation for the treatment of hyperthyroidism owing to the development of radio-active iodide, antithyroid drugs and the use of beta-receptor blockers such as propranolol. In the treatment of Graves' disease, the conditions such as persistant symptoms of hyperthyroidism with resistance to the antithyroid drugs, frequent relapses and increasing size of thyroid gland must be considered for the need of surgery. It is essential to maintain the euthyroid state before surgery in these cases, if not, the possibility of thyroid storm is increased from increased release of thyroid hormones owing to manipulation of surgery. In our case, the patient had been medicated for 6 years, however, the euthyroid state had not been achieved before the day of surgery. Under the judgement of difficulty for more control of hyperthyroidism the surgeon requested for operation without delay. Immediately after starting operation, the symptoms suggesting thyroid storm such as the abrupt onset of high fever, the increasing blood pressure and heart rate were occured. The sugery was stopped and then the management for thyroid storm was begun. At arterial blood gas analysis, respiratory acidosis and metabolic acidosis were developed and increased hilar haziness suggesting severe pulmonary edema were present in both lung fields at chest x-ray. The patient was mechanically ventillated until improvement of metabolic and respiratory acidosis and pulmonary edema. Two days after operation, vital signs were stabilized and the patient was transferred to general wards.
Acidosis ; Acidosis, Respiratory ; Antithyroid Agents ; Blood Gas Analysis ; Blood Pressure ; Fever ; Graves Disease ; Heart Rate ; Humans ; Hyperthyroidism ; Lung ; Patients' Rooms ; Propranolol ; Pulmonary Edema ; Recurrence ; Thorax ; Thyroid Crisis* ; Thyroid Gland* ; Thyroid Hormones ; Thyroidectomy* ; Thyrotoxicosis* ; Vital Signs

Allergic diseases are common in sports athletes, as they are in the general population. Any physician who involved in the care of athletes will commonly face the management of allergic conditions. Exercise-aggravated or exercise-induced allergic disorders are significant health problems to competitive athletes, although the majority of these disorders are mild and symptomatically annoying, several allergic diseases carry the risk of anaphylaxis and even sudden death. Meticulous approach in the diagnosis and management of allergic conditions is essential for the sports medicine physicians to afford all athletes can compete safely with their highest physical and mental level.
Anaphylaxis ; Asthma ; Athletes ; Death, Sudden ; Diagnosis ; Humans ; Sports ; Sports Medicine ; Urticaria

STUDY DESIGN: 3 cases report. OBJECTIVES: We present 3 cases of cervical myelopathy treated successfully by selective laminoplasty on 2 levels or less, using Kurokawa technique with a review of the relevant articles. SUMMARY OF LITERATURE REVIEW: As there were no clear criteria for the numbers of the laminae that require decompression in a standard laminoplasty, a wide level laminoplasty from C3 to C7 has been generally done. As a result, complications such as axial pain, C5 root paresis, and loss of range of motion have been reported commonly. To reduce these complications, recent studies have attempted less invasive procedures, such as selective laminoplasty or preservation of posterior ligament and muscle components. MATERIALS AND METHODS: There were two cases of developmental stenosis and one posterior compressive stenosis that underwent selective laminoplasty. The posterior shift of the spinal cord and the dural expansion were measured by magnetic resonance imaging at 3 or 4 weeks after surgery. Clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score. Axial pain was classified as follows; never: Grade 0; mild: Grade 1; moderate: Grade 2; and severe: Grade 4. RESULTS: The spinal cord had a tendency to shift posterioly and the dura mater was expanded in all cases. Clinical outcomes and axial pain were also improved in all. CONCLUSIONS: Selective laminoplasty that enabled the surgeon to perform a less invasive surgery preserving operative time and the patient to have a lower risk of C5 root paresis is effective for the developmental stenosis or posterior compressive stenosis less than 3 levels.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Dura Mater ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Operative Time ; Orthopedics ; Paresis ; Range of Motion, Articular ; Spinal Cord ; Spinal Cord Diseases