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*

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

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*

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

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 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*

BACKGROUND AND OBJECTIVES: Otoacoustic emissions (OAEs) are low level acoustic sounds of cochlear origin. They have several advantages over other methods in auditory testing, particularly in children. However, because of the crucial dependence of emission levels on the healthiness of the middle ear conduction system, some middle ear problems confound the interpretation of evoked OAEs (EOAEs). The purpose of this study is to evaluate the effects of middle ear condition (tympanometry) on DPOAEs and TEOAEs in normal hearers. Materials and Method : Tympanometry, TEOAEs and DPOAEs were measured in 42 subjects (68 ears) who were under 12 years old and have pure tone thresholds within 25 dB HL RESULTS: The OAEs pass rates for the three groups were as follows: 95 % for TEOAEs and 90 % for DPOAEs in the tympanogram type A group; 12 % for TEOAEs and 12 % for DPOAEs in the tympanogram type B group; 27.3 % for TEOAEs and 13.6 % for DPOAEs in the tympanogram type C group. The pass rate and sensitivity of EOAEs were much higher in the type A group than in the type B and C groups. CONCLUSION: OAEs are useful for screening the integrity of outer hair cells in the tympanogram type A group but not in the type B and C groups. Therefore, tympanometry that represents middle ear condition is recommended before the OAE test. In addition, if TEOAEs and DPOAEs are simultaneously performed, sensitivity will be increased.
Acoustic Impedance Tests ; Acoustics ; Child ; Ear, Middle* ; Hair ; Humans ; Mass Screening

BACKGROUND AND OBJECTIVES: The majority of tinnitus is classified not as objective, but as subjective tinnitus. The nature of tinnitus is different according to countries, cities, personal expression, but the objective assessment guideline for the diagnosis of subjective expression in tinnitus is not present in Korea. The aim of this study has been to compare subjective expressions with pitch in tinnitus and to find out whether we can predict tinnitus pitch by patient subjective expression. SUBJECTS AND METHOD: We reviewed the records of 633 patients (690 ears) with continuous tinnitus who performed questionnaires of tinnitus and audiologic study. In addition to standard audiometric tests, patients received tests for tinnitus pitch using pure tone stimuli and/ or narrow band noise. RESULTS: Among 50 onomatopoeia of tinnitus, [wi: ng] shows highest incidence (25.4%), followed by [s'oi: ](13.8%), [u: ng] (11.7%), [p'i: ](7.8%), and [tchi: ](5.4%). High pitches, especially 4 kHz (28.6%), 8 kHz (24.9%), were more frequently noted in tinnitus. With respect to the relationship between tinnitus pitch and onomatopoeia, [u: ng] shows highest incidence in low pitches, below 500 Hz, [wi: ng] in 1 kHz, and [s'oi: ] in 4 kHz, 8 kHz. In tinnitus pitch according to onomatopoeia, [wi: ng] had 4 kHz, 8 kHz, 1 kHz, [s'oi: ] had 4 kHz, 1 kHz, 8 kHz, [u: ng] had 125 Hz, 250 Hz, 500 Hz, [p'i: ] had 8 kHz, 4 kHz, 1 kHz, and [tchi: ] had 4 kHz, 8 kHz, more frequently in sequence. Dividing pitches into low, middle and high levels, [u: ng] had low pitches, [s'oi: ] had middle and high pitches, [p'i: ] and [tchi: ] had high pitches, but [wi: ng] was distributed evenly through low to high pitches. CONCLUSION: Our results suggest that there was apparent relationship between subjective expression and pitch in tinnitus.
Diagnosis ; Humans ; Incidence ; Korea ; Noise ; Pitch Perception ; Surveys and Questionnaires ; Tinnitus*