OBJECTIVES: The present study investigates the psychometric adequacy of the Hamilton Depression Scale-Self-Report(HAMD-Self-report) with respect to the measuring the severity of depressive symptom by the use of item-response models(two parameter logistic model). METHODS: 114 patients with depressive disorder as diagnosed by DSM-IV criteria were studied. All depressed patients were aged 22 years or older, with the mean age of 33. They were requested to fill up the questionnaires of Hamilton Rating Scale for Depression-Self-Report. The data was analysed by Bayesian 1.0 for windows for item analysis. RESULTS: 1) Of the 76 items that consist of HAMD-Self-report, only 66 fitted the Item response model. 2)The 66 items reflected the degree of depression necessary for each symptom to shift from 'low intensity' to 'moderate intensity', and from 'moderate' to 'high intensity'. 3) The subscales of feeling of guilty and weight loss were mainly consisted of items with high item severity. Therefore only the severely depressed subjects may response. The subscale work and activities was made of items with low item severity, and the subjects with much less severe may response. CONCLUSION: The 66 items that were fitted to the item response model represented the different level of depressive severity. By weighing each item differently with respect to the symtom severity parameter(item severity), each item on the subscales represents a different level of depressive severity. Therefore the total score computed by summing responses to the highest weighted item of each scale can be used as an adequate index of depressive severity.
Depression* ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychometrics ; Surveys and Questionnaires ; Weight Loss

The preoperative hearing status is one of the important factors to determine the method of surgical approach to the vestibular schwannoma. It has been widely recognized that the hearing preservation surgery is not valuable if the patient has no serviceable hearing. The worldwide reported cases of hearing improvement after surgical removal of vestibular schwannoma with profound hearing disturbance are extremely rare, and so far, there have been no domestic cases reported. The authors have experienced a case of significant hearing improvement after surgical removal of vestibular schwannoma with preoperative unilateral total deafness but with normal otoacoustic emission response. We report this case with literature review.
Deafness ; Hearing Loss* ; Hearing* ; Humans ; Neuroma, Acoustic*

PURPOSE: To evaluate three-dimensional volume-rendering of congenital inner-ear malfornations using the MR CISS (Constructive Interference in Steady State) sequence. MATERIALS AND METHODS: MR CISS images of 30 inner ears of 15 patients (M:F=10:5; mean age, 6.5years) in whom inner-ear malfornation was suspected were obtained using a superconducting Magnetom Vision System (Simens, Erlangen, Germany), with TR/TE/FA parameters of 12.25 ms/5.9 ms/70 degree. The images obtained were processed by means of the volume rendering technique at an advanced workstation (Voxtol 3.0.0; GE Systems, advanced workstation, volume analysis). The cochlea and three semicircular canals were morphologically evaluated. RESULTS: Volume-rendered images of 25 inner ears of 13 patients demonstrated cochlear anomalies in the form of incomplete partition (n=18), hypoplasia (n=2), and severe hypoplasia (n=5). For the superior semicircular canal, findings were normal in 15 ears, though common crus aplasia (n=6), hypoplasia (n=4), aplasia (n=3), and a short and broad shape (n=2) were also observed. The posterior semicircular canal of 13 ears was normal, but common crus aplasia (n=6), a short and broad shape (n=5), aplasia (n=4), hypoplasia (n=3) were also identified. Twelve lateral semicircular canals, were normal, but other images depicted a short and broad shape (n=7), a dilated crus (n=5), a broad shape (n=4), and aplasia (n=2). In 14 patients the anomalies were bilateral, and in seven, the same anomalies affected both ears. CONCLUSION: Three-dimensional volume rendering images of the inner ear depicted various morphological abnormalities of the cochlea and semicircular canals. At that locations, anomalies were more complicated and varied than in the cochlea. Three-dimensional volume rendering imaging using the MR CISS technique provides anatomical information regarding the membranous labyrinth, and we consider this useful in the evaluation of congenital inner ear malformations.
Cochlea ; Ear ; Ear, Inner* ; Humans ; Semicircular Canals

PURPOSE: About 10% of girls with Turner syndrome may have autoimmune thyroid disease(AIT), but the disease's pathophysiology has not yet been elucidated. Accordingly, this study was performed to observe whether the pathogenesis of AIT in children with Turner syndrome and without Turner syndrome correlate with special loci of DQ and chain in HLA. METHODS: Blood samples were drawn from children with and without Turner syndrome. Thyroid antibodies(anti-thyroglobulin and anti-microsomal antibody) were measured from the samples to determine AIT. DNAs were extracted with the DNA extraction kit and processed in PCR reaction for amplification of exon 2 region of HLA-DQA1 and -DQB1, and then eluted again. The eluted PCR products were sequenced directly with an automatic sequencer. The sequences were compared with those of normal control. RESULTS: There was a signficant increase in frequencies of HLA DQA1*0301(P<0.05) and HLA DQB1*0601 but without statistical significance(P=0.06) in normal children with AIT, compared with those in control group. There was signficantly but slightly increased frequency of HLA DQA1*0104, 0105 and DQB1*0202 in the group of children with Turner syndrome who had AIT than in control group. The frequency of the marker chromosome(45,X/46,XX+mar) increased in children with Turner syndrome who had AIT, compared with these in children with Turner syndrome who did not have AIT. Children with Turner syndrome who had spontaneous puberty had higher a incidence rate of AIT than those who did not have spontaneous puberty(P<0.01). CONCLUSION: The results suggest that HLA DQA1*0301 and HLA DQB1*0601 play a role in the pathogenesis of AIT in children without Turner syndrome, but not in children with Turner syndrome. Additionally, there seem to be other factors participating in the pathogenesis of AIT in children with Turner syndrome, such as chromosomal karyotype and spontaneous puberty. Therefore, the factors participitating in the pathogenesis of AIT in children with Turner syndrome remain to be elucidated with further study.
Adolescent ; Child* ; DNA ; Exons ; Female ; Humans ; Incidence ; Karyotype ; Polymerase Chain Reaction ; Puberty ; Thyroid Diseases* ; Thyroid Gland* ; Turner Syndrome*

OBJECTIVE: To estimate the status of HIV infection and AIDS incidence using a back-calculation model in Korea. METHODS: Back-calculation is a method for estimating the past infection rate using AIDS incidence data. The method has been useful for obtaining short-term projections of AIDS incidence and estimating previous HIV prevalence. If the density of the incubation periods is known, together with the AIDS incidence, we can estimate historical HIV infections and forecast AIDS incidence in any time period up to time t. In this paper, we estimated the number of HIV infections and AIDS incidence according to the distribution of various incubation periods RESULTS: The cumulative numbers of HIV infection from 1991 to 1996 were 708~1,426 in Weibull distribution and 918~1,980 in Gamma distribution. The projected AIDS incidence in 1997 was 16~25 in Weibull distribution and 13~26 in Gamma distribution. CONCLUSIONS: The estimated cumulative HIV infections from 1991 to 1996 were 1.4~4.0 times more than notified cumulative HIV infections. Additionally, the projected AIDS incidence in 1997 was less than the notified AIDS cases. The reason for this underestimation derives from the very low level of HIV prevalence in Korea. Further research is required for the distribution of the incubation period of HIV infection in Korea, particularly for the effects of combination treatments.
HIV Infections ; HIV* ; Incidence* ; Korea* ; Prevalence

BACKGROUND AND OBJECTIVES: Sudden deafness in the elderly is rare and its prognosis is poorer than in adults. The unaffected ear also may have hearing impairment of variable severity and physiological hearing threshold shift termed presbycusis in the elderly. The old person often had various systemic complications including diabetes and hypertension. This study was designed to evaluate clinical manifestations and prognosis of sudden deafness in the elderly and to compare with sudden deafness in adults and children. SUBJECTS AND METHOD: We reviewed the medical and audiological records of 96 patients (102 ears) who are more than 60 years of age, and admitted to the Department of Otolaryngology, Pusan National University Hospital from January 1990 to December 2001. RESULTS: The total recovery rate of sudden deafness was lower in the elderly than in adults and children. Hearing recovery was significantly poorer in the patients with diabetes and hypertension. Hearing recovery was significantly poor in the patients with profound degree of hearing loss. The patients who had been treated within 7 days after onset of hearing loss showed better recovery rate than those treated 7 days later. CONCLUSION: We consider the effect of treatment of sudden deafness in the elderly to be best judged in various degrees of hearing impairment in the unaffected ear. The poor prognosis observed in patients with the concurrent disease is likely to have been brought about by preexisting microvascular diseases of the hearing organ, which is highly affected by aging. Good hearing recovery in the elderly is considered to be associated with time of initial treatment and expected in patients without concurrent diseases.
Adult ; Aged* ; Aging ; Busan ; Child ; Ear ; Hearing ; Hearing Loss ; Hearing Loss, Sudden* ; Humans ; Hypertension ; Otolaryngology ; Presbycusis ; Prognosis

It has been assumed that tension and anxiety serve to induce or exacerbate tinnitus through increasing muscle tension or alteration in blood flow to the cochlear region. And it is also possible that psychological distress may be a result of tinnitus, or that awareness of tinnitus may be greater during environmental stress. So tinnitus patients need psychologic consideration in their diagnosis and treatment. Purpose of this study is to evaluate the degree and characteristic of the psychologic factors in tinnitus disorder. Cornell Medical Index(CMI), Fukamachi's Discriminative chart and Symptom Check List-90-Revision(SCL-90-R) were examed in tinnitus patients and control group. The results were as follows. 1) According to the Fukamachi's Discriminative Chart using CMI, the tinnitus group showed higher incidence than normal healthy adults group in class III or IV region which is regarded as neurosis. 2) The tinnitus group showed higher score than normal healthy group in all 9 sections of SCL-90-R. 3) The group which has long duration of tinnitus was related to high scores of interpersonal sensitivity, depression, anxiety, and the group which has not history of otologic surgery was related to high scores of depression, phobic anxiety(p<0.01).
Adult ; Anxiety ; Depression ; Diagnosis ; Humans ; Incidence ; Muscle Tonus ; Tinnitus*

BACKGROUND: Tongue cancer comprises 10% of all head and neck cancer, and in spite of progress of therapeutic and diagnostic procedures in oncology, the prognosis of tongue cancer remains poor because of rich lymphatics of the tongue and high propensity of early subclinical lymph node metastasis. MATERIALS AND METHODS: Eighteen cases of tongue cancer specimens were sectioned serially and reviewed to investigate the correlations between macroscopic surface extension diameter and microscopic depth of invasion. And correlations between surface extension, muscular invasion and cervical lymph node metastasis of tongue cancer were studied. Furthermore, safety margin for glossectomy was also studied. RESULTS: The obtained results were as follows: 1) The macroscopic diameter of surface extension and microscopic depth of invasion of tongue cancer were correlated to each other (especially when the macroscopic diameter of surface extension was below 20 mm).2) Surface extension and muscular invasion were correlated independently with cervical lymph node metastasis. However, the 95% confidence index using the Cornfield method was too broad in order to draw a correlation among these three factors. 3) The safety margin was between 2.3mm and 13.5 mm. CONCLUSION: Macroscopic surface extension of tongue cancer serves as a valuable prognostic factor in predicting the depth of muscular invasion. Therefore, the safety resection depth can be estimated by the surface extension. In 12 cases of muscular invasions, relatively high prevalence of cervical lymph node metastasis were found, when compared to that of non-muscular invasive cancer. Therefore, muscular invasion itself is a very useful prognostic factor. But it is difficult to confirm the correlation between muscular invasion and cervical lymph node metastasis because of too broad CI.
Glossectomy ; Head and Neck Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Prevalence ; Prognosis* ; Tongue Neoplasms* ; Tongue*

BACKGROUND AND OBJECTIVES: The acute effect of alcohol is well known. However, although many authors have studied the effect of alcohol on equilibrium and found a deteriorated balancing capacity, objective studies of deteriorated balancing capacity have rarely been reported. The object of this study is to assess the effect of alcohol on vestibular function impairment by dynamic posturography. MAERIALS AND METHODS: Twelve healthy male volunteers aged 23-27 years (mean 25years) were assessed by dynamic posturography 30 min, 60 min and 90 min before and after the ingestion of alcohol. Alcohol levels were measured by blood samples 30, 60 and 90 min before, at and after ingestion. The samples were analyzed for alcohol by chromatography (SIGMA diagnostics). Each condition in SOT and latencies in MCT were used to estimate the effect of alcohol. RESULTS: The obtained results were as follows: 1) The time when serum alcohol concentration reach the maximum was 60 minute (50%). 2) Conditions 4, 5, 6 and composite scores showed statistically significant lower equilibrium scores (p<0.05). 3) Fourty-one percent showed normal SOT pattern, 33.3% showed generalized lower scores for all the conditions, 16.7% showed lower scores for the conditions 4, 5, and 6, and 8.3% showed lower scores for the conditions 5 and 6. 4) No significant effects were found for the latencies of MCT (p>0.05). CONCLUSION: Acute alcohol ingestion influences impairment of vestibular and visual input on equilibrium.
Chromatography ; Eating ; Humans ; Male ; Volunteers

BACKGROUND AND OBJECTIVES: The biologic changes in recurrent laryngeal cancer following radiotherapy are not fully understood. The authors investigated the expression of p53 and proliferating cell nuclear antigen (PCNA) in patients with locally recurrent laryngeal cancer after radiotherapy. MATERIALS AND METHODS: The authors investigated the expression of p53 and PCNA by immunohistochemical stain in 15 patients with recurrent laryngeal cancer after radiotherapy. RESULTS: The expression of p53 protein was significantly different between laryngeal cancer before radiotherapy (4/15, 26.7%) and recurrent laryngeal cancer after radiotherapy (8/15, 53.3%) (p<0.05). Also, PCNA index was significantly different between laryngeal cancer before radiotherapy (mean, 11.9%) and recurrent laryngeal cancer after radiotherapy (mean, 18.0%) (p<0.05). CONCLUSION: The expressions of p53 protein and PCNA were increased more in the recurrent laryngeal cancer after radiotherapy than in the laryngeal cancer before radiotherapy. Recurrent laryngeal cancers changed to biologically aggressive cancer after following radiation therapy.
Genes, p53 ; Humans ; Laryngeal Neoplasms* ; Proliferating Cell Nuclear Antigen* ; Radiotherapy*