Parkinsonism is a very rare complication of phenytoin. The authors experienced a 71-year-old man who presented progressive cognitive decline, postural tremor, bradykinesia and gait disturbance. Laboratory test and brain imaging revealed no abnormality that commonly causes parkinsonism. The only abnormal finding was elevation of serum phenytoin above the therapeutic level. The patient showed marked improvement of symptoms by reduction of phenytoin dosage. Here we report a case of phenytoin induced parkinsonism.
Aged ; Gait ; Humans ; Hypokinesia ; Neuroimaging ; Parkinsonian Disorders ; Phenytoin ; Tremor

Takotsubo syndrome, also known as stress-induced cardiomyopathy, is a transient cardiac syndrome that mimics acute coronary syndrome. This condition should be suspected if the patient presents with chest pain after intense emotional stress, accompanied by an abnormal electrocardiogram, elevated levels of myocardial enzymes, and left ventricular apical akinesia on echocardiography. Coronary angiography should be performed for prompt differentiation from ischemic heart disease. A 77-year-old female presented with traumatic multiple fractures of the left sixth and seventh ribs resulting from a violent strike. Clinical findings of physical examination, laboratory tests, electrocardiogram, and coronary angiography provided the diagnosis of Takotsubo syndrome. We performed conservative management including pain control, and the patient was uneventfully discharged seven days after admission.
Acute Coronary Syndrome ; Aged ; Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Diagnosis ; Echocardiography ; Electrocardiography ; Female ; Fractures, Multiple ; Humans ; Myocardial Ischemia ; Physical Examination ; Rib Fractures* ; Ribs* ; Stress, Psychological ; Strikes, Employee ; Takotsubo Cardiomyopathy*

This study focused on the socialist camp's North Korean medical support and its effects on North Korean medical field from liberation to 1958. Except for the Soviet assistance from liberation to the Korean War, existing studies mainly have paid attention to the ‘autonomous’ growth of the North Korean medical field. The studies on the medical support of the Eastern European countries during the Korean War have only focused on one-sided support and neglected the interactions with the North Korean medical field. Failing in utilizing the materials produced in North Korea has led to the omission of detailed circumstances of providing support. Since the review of China's support and the North Korea-China medical exchanges has been concentrated in the period after the mid-1950s, the impacts of China's medical support on North Korea during the Korean War period and the post-war recovery period have not been taken into account. In terms of these limitations, this study examined the medical activities by the Socialist camp of the Eastern European countries in North Korea after the Korean War. The medical aid teams from Hungary, Romania, Bulgaria, Czechoslovakia, Poland, and East Germany that came to North Korea in the wake of the Korean War continued to stay in North Korea after the war to build hospitals and train medical personnel. In the hospitals operated by these countries, cooperative medical care with North Korean medical personnel and medical technology education were conducted. Moreover, medical teams from each country in North Korea held seminars and conferences and exchanged knowledge with the North Korean medical field staffs. These activities by the Socialist countries in North Korea provided the North Korean medical personnel with the opportunity to directly experience the medical technology of each country. China's support was crucial to North Korea's ‘rediscovery’ of Korean medicine in the mid-1950s. After the Korean War, North Korea began to apply the Chinese-Western medicine integration policy, which was performed in China at that time, to the North Korean health care field through China's medical support and exchanges. In other words, China's emphasis on Chinese medicine and the integration of the Chinese-Western medicine were presented as one of the directions for medical development of North Korea in the 1950s, and the experiences of China in this process convinced North Korea that Korean medicine policy was appropriate. The decision-makers of the North Korean medical policies, who returned to North Korea after studying abroad in China at that time, actively introduced the experiences from China and constantly sought to learn about them. This study identified that a variety of external stimuli had complex impacts on the North Korean medical field in the gap between ‘Soviet learning’ in the late 1940s and the ‘autonomous’ medical development since the 1960s. The North Korean medical field was formed not by the unilateral or dominant influences of a single nation but by the stimulation from many nations and the various interactions in the process.
Asian Continental Ancestry Group ; Bulgaria ; China ; Congresses as Topic ; Czechoslovakia ; Delivery of Health Care ; Democratic People's Republic of Korea ; Education ; Germany ; Humans ; Hungary ; Korean War ; Learning ; Poland ; Romania ; USSR

OBJECTIVE: The goal of the present study was to evaluate demographic and clinical factors that affect the intention to participate in commonly-conducted research in patients with schizophrenia. METHODS: Thirty-four outpatients with a diagnosis of schizophrenia were enrolled in this study. They were asked whether they would have any intention to participate in four imaginary studies: a simple questionnaire, a genetic study, a study of complex tasks and a risky study. We analyzed the differences in general psychopathology, insight and demographic characteristics of the participants according to their responses (acceptance or refusal) to the four proposed studies. RESULTS: Younger and better-educated patients tended to decline participation in a risky study. Patients with a longer duration of regular psychiatric follow-ups tended to willingly participate in the simple questionnaire. There were no overall statistical differences in general psychopathology and insight between patients who agreed or declined to participate in studies. CONCLUSION: Age and education level may be factors that influence decisions to participate in schizophrenia studies. Further research is needed to confirm and expand on the current findings.
Demography ; Follow-Up Studies ; Humans ; Informed Consent ; Intention ; Outpatients ; Patient Participation ; Pilot Projects ; Psychopathology ; Surveys and Questionnaires ; Research Subjects ; Schizophrenia

Stroke is one of the leading causes of deaths in Korea. According to the report from Korean National Statistical Office, the mortality rate of stroke was 77.2/100,000 persons in 2002. In the past, hemorrhagic stroke was more prevalent than ischemic stroke in Korea. However, the ratio of hemorrhagic to ischemic stroke has been reversed since late-1980s. This trend might be due to the westernization of lifestyle as well as better control of stroke risk factors such as hypertension and diabetes. Of ischemic stroke, the incidence of cardioembolism is relatively low in Korea compared with in Western countries, especially in posterior circulation disorders. This observation reflects the epidemiologic characteristic of stroke in Korea where the prevalence of cardiac diseases is relatively low. The case fatality rate from one of the largest hospital-based stroke registries was 7.7% within 30 days after the onset of acute ischemic stroke, which is similar to those from other series in western countries with advanced medical care systems. However, the delay of hospital visit after the onset of stroke and the lower compliance for secondary prevention remain obstacles in managing stroke patients in Korea.
Cause of Death ; Compliance ; Epidemiology ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Korea ; Life Style ; Mortality ; Prevalence ; Registries ; Risk Factors ; Secondary Prevention ; Stroke

Pheniramine maleate(avil(R)) is a H1-antagonist that is derived from alkylamine. Skin reactions with parenteral administration of avil(R) are uncommon. A 29-year-old woman visited our department with a 3-year history of relapsing generalized multiple pruritic evanescent erythematous wheals after antihistamine and steroid injection. Intradermal skin test with Avil(R) was positive. We treated with 5 mg of mequitazine administration three times a day for 2 years.
Adult ; Female ; Humans ; Pheniramine* ; Skin ; Skin Tests ; Urticaria*

BACKGROUND: There has been proposing reports that the autonomic nervous system (ANS) is involved in the pathophysiological mechanism of migraine. However, previous reports suggesting ANS dysfunction during migraine attack was not consistent and were focused mainly on comparison between migraine patients in interictal period and normal controls. The current study is designed to evaluate quantitative evidence of ANS dysfunction by comparing patients in ictal period with those in interictal period. METHODS: We prospectively included 30 migraineurs in ictal period and 30 migraineurs in interictal period from August 2008 to August 2009. Sympathetic function was evaluated by blood pressure response to standing and isometric exercise. Parasympathetic function was evaluated by heart rate response to deep breathing, standing and the Valsalva maneuver. RESULTS: In orthostatic test, falling of systolic blood pressure (SBP) after standing was prominent in ictal group. Although both groups showed elevation of diastolic blood pressure (DBP) after standing, the change was smaller in ictal group than intercital group. Elevation of DBP after isometric exercise was lower in ictal group without statistical significance. Results of parasympathetic function test were not significantly different between ictal and interictal patients. CONCLUSIONS: This study suggests that subjects with migraine had sympathetic hypofunction during migraine attack.
Autonomic Nervous System ; Blood Pressure ; Exercise ; Heart Rate ; Humans ; Migraine Disorders ; Prospective Studies ; Respiration

OBJECTIVES: The present study was designed to assess the reliability and validity of Korean version of Family Questionnaire (FQ-K), a brief questionnaire measuring expressed emotion (EE). METHODS: A sample of 84 first-order relatives of schizophrenics completed the FQ-K and the data were analyzed for internal consistency and factor structure. Additionally non-random subset of participants (n=34) refilled FQ-K after two weeks for testretest reliability and naturalistic follow-up data of 36 were obtained for any re-hospitalization events to assess predictive validity. RESULTS: Internal consistency of FQ-K was good (Cronbach's alpha=.819) and principal component factor analysis revealed the two-factor structure (criticism and emotional overinvolvement) identical to previously reported for the FQ. The FQ-K also showed reasonable test-retest reliability and excellent predictive validity was indicated in that outcome of re-hospitalization was superior for low expressed emotion patients at six-month naturalistic follow-up. CONCLUSION: The Korean version of FQ proved to be a reliable and valid instrument measuring expressed emotion in relatives of Korean patients with schizophrenia.
Expressed Emotion* ; Follow-Up Studies ; Humans ; Surveys and Questionnaires* ; Reproducibility of Results* ; Schizophrenia

Laryngeal amyloidosis is a rare disease that was first documented in 1875. The incidence of the larynx limited amyloidosis is less than 1% of all benign lesions of larynx. It may occur as primary or secondary to other diseases. Generalized secondary amyloidosis is very rare among them. It is a condition characterized by the extracellular deposition of homogenous, eosinophilic, proteinous material in the form of fibrils. The aim of treatment is to maintatin or improve voice quality and to maintain laryngeal airway. We report a case of laryngeal amyloidosis of AL (amyloid light chain) type that was treated with KTP laser (potassium titany phosphate laser).
Incidence

OBJECTIVES: Schizophrenic patients have been shown to be impaired in both emotional self-awareness and recognition of others' facial emotions. Alexithymia refers to the deficits in emotional self-awareness. The relationship between alexithymia and recognition of others' facial emotions needs to be explored to better understand the characteristics of emotional deficits in schizophrenic patients. METHODS: Thirty control subjects and 31 schizophrenic patients completed the Toronto Alexithymia Scale-20-Korean version (TAS-20K) and facial emotion recognition task. The stimuli in facial emotion recognition task consist of 6 emotions (happiness, sadness, anger, fear, disgust, and neutral). Recognition accuracy was calculated within each emotion category. Correlations between TAS-20K and recognition accuracy were analyzed. RESULTS: The schizophrenic patients showed higher TAS-20K scores and lower recognition accuracy compared with the control subjects. The schizophrenic patients did not demonstrate any significant correlations between TAS-20K and recognition accuracy, unlike the control subjects. CONCLUSIONS: The data suggest that, although schizophrenia may impair both emotional self-awareness and recognition of others' facial emotions, the degrees of deficit can be different between emotional self-awareness and recognition of others' facial emotions. This indicates that the emotional deficits in schizophrenia may assume more complex features.
Affective Symptoms ; Anger ; Humans ; Schizophrenia