OBJECTIVE: Panic disorder has been suggested to be divided into the respiratory and non-respiratory subtypes in terms of its clinical presentations. The present study aimed to investigate whether there are any differences in treatment response and clinical characteristics between the respiratory and non-respiratory subtypes of panic disorder patients. METHODS: Among the 48 patients those who completed the study, 25 panic disorder patients were classified as the respiratory subtype, whereas 23 panic disorder patients were classified as the non-respiratory subtype. All patients were treated with escitalopram or paroxetine for 12 weeks. We measured clinical and psychological characteristics before and after pharmacotherapy using the Panic Disorder Severity Scale (PDSS), Albany Panic and Phobic Questionnaire (APPQ), Anxiety Sensitivity Index-Revised (ASI-R), State-Trait Anxiety Inventory (STAI-T, STAI-S), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D). RESULTS: The prevalence of the agoraphobia was significantly higher in the respiratory group than the non-respiratory group although there were no differences in gender and medication between the two groups. The respiratory group showed higher scores on the fear of respiratory symptoms of the ASI-R. In addition, after pharmacotherapy, the respiratory group showed more improvement in panic symptoms than the non-respiratory group. CONCLUSION: Panic disorder patients with the respiratory subtype showed more severe clinical presentations, but a greater treatment response to SSRIs than those with non-respiratory subtype. Thus, classification of panic disorder patients as respiratory and non-respiratory subtypes may be useful to predict clinical course and treatment response to SSRIs.
Agoraphobia ; Anxiety ; Citalopram ; Classification ; Depression ; Drug Therapy ; Humans ; Panic ; Panic Disorder* ; Paroxetine ; Prevalence ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Treatment Outcome

Purpose: There are various neurogenic bladder patterns that occur in patients during stroke. Among these patterns, the focus was mainly on the patient’s facial parsy diagnosis. Stroke requires early response, and it is most important to identify initial symptoms such as facial parsy. There is an urgent need for a diagnostic technology that notifies patients and caregivers of the onset of disease in the early stages of stroke. We developed an artificial intelligence (AI) stroke early-stage analysis software that can alert the early stage of stroke through analysis of facial muscle abnormalities for the elderly neurogenic bladder prevention. Methods: The method proposed in this paper developed a learning-based deep learning analysis technology that outputs the initial stage of stroke after acquiring a high-definition digital image and then deep learning face analysis. The applied AI model was applied as a multimodal deep learning concept. The system is linked and integrated with the existing urine management integrated system to support patient management with a total-care concept. Results: We developed an AI stroke early-stage analysis software that can alert the early stage of stroke with 86% hit performance through analysis of facial muscle abnormalities in the elderly. This result shows the validation result of the landmark image learning model based on the distance learning model. Conclusions We developed an AI stroke early-stage diagnostic system as a wellness personal medical service plan and prevent cases of missing golden time when existing stroke occurs. In order to secure and facilitate distribution of this, it was developed in the form of AI analysis software so that it can be mounted on various hardware products. In the end, it was found that using AI for these stroke diagnoses and making them quickly and accurately had a positive effect indirectly, if not directly, on the neurogenic bladder.

No abstract available.
Ataxia* ; Cerebellar Ataxia ; Infarction* ; Middle Cerebral Artery*

PURPOSE: The objective of this study was to translate the obesity-related problems (OP) scale for Koreans and to validate it for use in Korean populations. METHODS: Translation and back-translation of the OP scale was performed and a pilot test was conducted. Following this, patients who had received treatment at the Obesity Center of Inha University Hospital were selected for participation in the field test. Cronbach's alpha (alpha) was used for assessment of the internal consistency of the OP scale. Spearman's correlation coefficients were used to assess the concurrent validity between the OP scale, the EuroQoL-5D (EQ-5D), and the Beck depression inventory (BDI) scale. One-way analysis of variance and t-test were used to assess the factors associated with the OP scale. RESULTS: A total of 67 individuals participated in the field study. The standardized Cronbach's alpha of the OP was 0.913. A significant negative correlation was observed between the OP scale and the EQ-5D and a positive correlation was observed between the OP scale and the BDI (the correlation coefficient with EQ-5D = -0.316, and the BDI = 0.305, P < 0.05). CONCLUSION: The results of this study prove that the Korean version of the OP has been translated and adapted correctly in order to meet the standard of its use.
Depression ; Humans ; Obesity ; Quality of Life ; Surveys and Questionnaires

Purpose: This study aimed to identify trends in changes of cognitive function, physical function, depression, and activities of daily living (ADL) among people with dementia who had used day care centers for at least 12 months, through the analysis of data collected from day care center records. Methods: The participants in this descriptive survey were 63 older people with dementia. Data were collected from two dementia day care centers located in Incheon city. General characteristics and disease related characteristics were analyzed in terms of the frequency, percentage, mean, and standard deviation. Correlations between major variables were analyzed using Pearson correlation coefficient. Cognitive function, depression, physical performance, and ADL were analyzed using the mean, standard deviation, Wilcoxon signed-rank test, and Friedman test. Results: The mean age of the participants was 77.33±6.73 years (range, 58 to 91 years) when they began attending the centers. Cognitive function significantly increased at 3 months (18.63±5.06), 6 months (18.73±5.20), and 12 months (18.63±5.43) compared to baseline (17.41±4.77). Depression significantly decreased at 3 months(2.94±2.96), 6 months (3.13±3.14), and 12 months (2.81±3.27) compared to baseline (5.20±3.87). At 3 months, 6 months, and 12 months, the physical function score (respectively 10.19±2.90, 10.33±2.84, 10.11±2.55) increased significantly compared to baseline (9.13±3.01). ADLs decreased at 3 months (8.51±1.92), 6 months (8.67±2.12), and 12 months (8.89±2.19) compared to baseline (8.41±1.88). Conclusion Without receiving customized day care service for dementia, cognitive function and physical function will decline and depressive feelings will increase. Therefore, delaying cognitive decline, reducing depression, and improving physical function through the use of day care services, especially at an early stage are essential to strengthen and maintain aging in place.

BACKGROUND: Paradoxical embolism through the patent foramen ovale (PFO) is a well-recognized mechanism for otherwise unexplained ischemic stroke. Although transthoracic contrast echocardiography (TCE) has been used frequently for noninvasive diagnosis of right to left shunt through PFO, its diagnostic accuracy appears limited, especially in patients with poor acoustic window. Since harmonic imaging (HI) can enhance the definition of contrast microbubbles, theoretical advantages of HI in the detection of right to left shunt through PFO using microbubbles can be considered. However, there are few data regarding the diagnostic efficacy of HI in the detection of right to left shunt through PFO. The purpose of this study was to compare the diagnostic value of transthoracic HI in the detection of right to left shunt through PFO in patients with stroke with that of fundamental imaging (FI). Methods: One hundred thirty-six consecutive patients with stroke (82 male, mean age:9) underwent TCE in both HI and FI and transesophageal echocardiography (TEE) during rest and Valsalva maneuver with intravenous administration of agitated saline. PFO was judged to be present if microbubbles appeared in the left atrium within 3 cardiac cycles of their appearance in the right atrium. TEE was regarded as the gold standard for assessing the diagnostic accuracy of TCE. Results: Right to left shunt through PFO was detected in 40 of 136 patients by TEE (29.4%). FI of TCE detected shunt through PFO in only 9 of 136 patients (6.6%). In contrast, HI detected shunt through PFO in 25 of 136 patients (18.4%). The overall sensitivity and specificity of FI and HI for detection of right to left shunt through PFO were 22.5%, 62.5% (p<0.05) and 100%, 100%, respectively. Valsalva maneuver during HI significantly increased the detection rate of shunt through PFO (during rest in 9 and during Valsalva maneuver in 25, p<0.05). CONCLUSION: HI with contrast microbubble injection significantly enhanced the detection of right to left shunt through PFO in patients with ischemic stroke compared with FI by transthoracic approach.
Acoustics ; Administration, Intravenous ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Heart Atria ; Humans ; Male ; Microbubbles ; Sensitivity and Specificity ; Stroke ; Valsalva Maneuver

BACKGROUND: The role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine. METHODS: Ultrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3–4, T7–8, and T10–11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3–4, T7–8, and T10–11 and the location of each marker was confirmed by fluoroscopy. RESULTS: In the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 (p = 0.001), especially in T10–11 (group 1, 93.2%; group 2, 43.2%; p = 0.001) and T7–8 (group 1, 86.4%; group 2, 56.8%; p = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, r = 0.76; group 2, r = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects (p = 0.001), especially in group 1. CONCLUSIONS: Ultrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.
Acoustics ; Fluoroscopy* ; Nerve Block ; Ribs ; Spine* ; Ultrasonography

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential. METHODS: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours. RESULTS: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035). CONCLUSION: Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.
Cerebral Infarction ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Medical Records ; Neurologic Manifestations* ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

A schwannoma, also known as neurilemmoma, is a relatively rare benign tumor originating from the schwann cells of the nerve sheath. It occurs along any somatic, sympathetic and cranial nerves except the olfactory and optic nerves. It occurred most frequently in the head and neck but rarely in the nasal cavity and paranasal sinuses. Occurrence was especially rare in the nasal vestibule. Recently we experienced an unusual case of the schwannoma involving the left nasal vestibule. The mass was completely removed via a sublabial approach and histopathological examination and immunohistochemical staining study confirmed the schwannoma. We report this case with review of literatures.
Cranial Nerves ; Head ; Nasal Cavity ; Neck ; Neurilemmoma ; Optic Nerve ; Paranasal Sinuses ; Schwann Cells

Background: Interscalene brachial plexus block (ISBPB) is commonly used with general anesthesia for postoperative pain management in shoulder surgery. This study investigated the incidence of hypothermia and changes in the body temperature in patients undergoing arthroscopic shoulder surgery under ISBPB with propofol sedation. Methods: This retrospective study enrolled 220 patients who underwent arthroscopic shoulder surgery. Patients were divided into general anesthesia (n = 34) and ISBPB with propofol sedation (n = 186) groups, and medical records were retrospectively compared. In addition, patients from the ISBPB group were further divided according to age (elderly, [≥ 65 years]; n = 98 vs. young, [< 65 years]; n = 88), and the incidence of hypothermia and changes in the body temperature were compared. Results: Twenty-seven patients (12.3%) experienced perioperative hypothermia (range; 35.3–35.9℃). The incidence of perioperative hypothermia was 29.4% and 9.1% in the general anesthesia and ISBPB groups, respectively, and there was a significant difference between the two groups (P = 0.002). The incidence of perioperative hypothermia according to age in the ISBPB group was 9.2% and 9.1% in the elderly and young groups, respectively, and there was no significant difference between the two groups (P = 0.983). Conclusions The incidence of perioperative hypothermia during arthroscopic shoulder surgery under ISBPB with propofol sedation is lower than that under general anesthesia. Furthermore, when using ISBPB with propofol sedation, the incidence of perioperative hypothermia in elderly patients is similar to that in younger patients.