BACKGROUND: Allergic rhinitis is often associated with bronchial asthma, and intranasal treatment with topical corticosteroids reduces bronchial responsiveness. OBJECTIVE: In this study, it was evaluated that the bronchial responsiveness to methacholine increased in non-asthmatic adults with house dust mites (HDM)-sensitive allergic rhinitis compared to those without, chronic nasal symptoms. SUBJECTS AND METHODS: A questionnaire, skin prick t,est to common inhalant allergens, and methacholine bronchial provocation test (MBPT) were performed in a total of 216 subjects, who were composed of 40 non-asthmatic subjects with HDM-sensitive allergic rhinitis (HAR), 63 HDM-sensitive subjects without nasal symptoms (HS), and 113 non-atopic subjects without nasal symptoms (NHS). The bronchial responsiveness was evaluated by positive rate of MBPT (PC,-methacholine200mg/ml), provocative concentration of methacholine at which FEV, decline to 15% compared to baseline value (PC,-methacholine), and slope of dose-response curve (%fall of FEV, / log[last concentrat,ion of methacholine, mg/ml]). RESULTS: Positive rate of MBPT was significantly increased in HAR than in HS and NHS, and there was no difference between HS and NHS (77.9% vs. 50.7% vs. 38.0%). Log PC[5- methacholine was lower in HAR than in HS and NHS, and lower in HS than in NHS (mean+ SE, 1.568+0.126 vs. 2.05+0.085 vs. 2.277+0.047). Slope of dose-response curve was higher in HAR than in HS and NHS, and there was no difference bet,ween HS and NHS (mean+SE, 22.7 + 11.3 vs. 7.3+ 1.2 vs. 4.9+ 0.5%/mg/ml); CONCLUSION: In non-asthmatic adults with HDM-sensitive allergic rhinitis, the bronchial responsiveness to methacholine increased compared to those without chronic rhinitis.
Adrenal Cortex Hormones ; Adult ; Allergens ; Asthma ; Bronchial Provocation Tests ; Dust* ; Humans ; Methacholine Chloride* ; Pyroglyphidae* ; Rhinitis ; Skin ; Surveys and Questionnaires

OBJECTIVES: This study was designed to evaluate differences in the quality of life(QOL) according to insight in patients with schizophrenia. The author speculated that insight might have an effect on individual's QOL, especially subjective QOL. METHOD: The study group consisted of patients with schizophrenia(N=55). Subjects were divided into two groups, patients with insight(N=22)and without insight(N=15), based on Scale of Unawareness of Mental Disorders(SUMD). All of the patients were administered the Quality of Life Interview (QOLI)by Lehman and compared in objective and subjective QOL between two groups. Additionally, they completed BDI and F scale on MMPI. RESULTS: The patients with insight showed a tendency of lower scores in total subjective QOLI scores and the safety issues compared to the patients without insight although not significant statistically. And they showed significantly less satisfaction with social relations. In objective QOL, there are no statistically significant differences between two groups. CONCLUSION: Such differences support the notion that schizophrenic patients with insight are less satisfied with their lives, especially in the aspect of interpersonal relations. It reflects the awareness of functional decline due to lifetime disability, disconnection from social relations, poor resources and supports, social stigma, and also depressive or anxiety symptoms. The authors propose that the treatment strategies for schizophrenia must include concern and support for domains of life with which patients feel themselves least satisfied, to increase effectiveness and efficacy of treatment and improve QOL.
Anxiety ; Humans ; Interpersonal Relations ; MMPI ; Quality of Life* ; Schizophrenia* ; Social Stigma

BACKGROUND: Bronchoconstriction associated with aerosolized agents delivered by a metered dose inhaler (MDI) is relatively uncommon, but has been of particular interest. MATERIAL AND METHOD: In this study, we investigated to what extent the inert ingredients and propellants (freons) influence pulmonary function in 25 asthmatic patients. Forced expiratory volume in one second(FEV,) was measured by spirometry, Autospira HI 498(Chest, Japan) before and 1, 3, 5 and 10 minutes after the inhalation of saline control and MDI-placebo containing freons and inert ingredients. RESULT: Twenty four % (6/25) of asthmatics experienced a decrease in FEV20 by 10% or greater when compared to saline control. Number of positive cases in steroid dependent asthmatics is significantly higher compared to non-steroid dependent asthmatics. (p<0.05) Bronchoconstriction associated with the use of MDI-placebo appeared within 3 to 5 minutes and resolved spontaneouly at 10 minutes after the inhalation. CONCLUSION: The bronchoconstrictive response induced by MDI might be caused by the pro-pellants and/or the other inert ingredients contained in MDIs.
Bronchoconstriction ; Chlorofluorocarbons ; Forced Expiratory Volume ; Humans ; Inhalation ; Metered Dose Inhalers ; Spirometry

BACKGROUND: Exercise can aggravate asthmatic symptoms in many patients with bronchial asthma. It is caused by that inhaled air bypasses nasal cavity and goes directly to the lower airways through open mouth dring exercise. Although the pathogenetic mechanisms of exercise-induced asthma(EIA) have not been clarified yet, there is evidence that chemical mediators, released from the inflammatory cells triggered by airway cooling or drying, might be responsible for induction of bronchoconstriction. However, it has been controversial which chemical mediators or cells are involved in such process. Objectiye . The aim of this study was to evaluate the role of activated mast cells in the pathogenesis of EIA and find out whether or not sulfidopeptide leukotrienes (LTC4/d4/E4) are involved in the exercise-induced bronchoconstriction. MATERIAL AND METHOD: Eleven asthmatics with documented exercise-induced bronchoconstriction and 10 control subjects were studied. Before and 6 hours after free running for 6 minutes, forced expiratory volume in 1 second (FEV,) and the concentrations of N- methylhistamine, LTE4, and creatinine in unine collected for 6 hours after exercise were determined. RESULT: Urinary concentrations of N-methylhistamine(mean+SE, ng/mg creatinine) of EIA patients before and after exercise were 159+40 and 450+75, respectively. Those of control subjects were 208+ 54 and 275+ 62, respectively. Uninary N-methylhistamine levels of EIA group increased significantly after exercise, while those of control group did not change. Urinary concentrations of LTE,(mean+SE, pg/mg creatinine) of EIA patients before and after exercise were 15.6 k2.6 and 22.2+5.8, respectively. Those of control subjects were 10.4+ 4.0, 18.2 +7.0, respectively. The concentrations of LTE4 in the urine samples collected before exerise revealed no difference between EIA and control subjects (p=0.07). There was no change after exercise in both groups. Percent fall of FEV, was 29.1+8.0% (mean+SD) in EIA group and 3.4 + 4.0% in control group, respectively. There was no correlation between reduction of FEV, and change in urinary concentrations of N-methyl-histmine after exercise. CONCLUSTION: Chemical mediators of activated mast cells may be involved in exercise-induced bronchoconstriction, but there is little evidence for enhanced sulfidopeptide leukotriene generation as assessed by urinary LTE4.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Creatinine ; Forced Expiratory Volume ; Humans ; Leukotriene E4 ; Leukotrienes ; Mast Cells ; Mouth ; Nasal Cavity ; Running

OBJECTIVES: Recently, Korean psychiatrists have noticed the complaints from probands and family members that private health insurance companies do not pay for most psychiatric disorders. Furthermore, probands cannot even apply for insurance because of their medical record of psychiatric disorders. Authors investigated and reviewed contracts of Korean private insurance companies to find reasons for banning psychiatric disorders from insurance policies. METHODS: Authors reviewed more than 800 contracts from 48 insurance companies. RESULTS: Among all the psychiatric diagnoses, few of them-dementia and some other organic mental disorders-are guaranteed to be paid from insurance companies. Less then 10 contracts say they pay for psychiatric illnesses. Most insurance companies have contracts prohibiting F codes ; however, there are not enough reasons in these contracts. CONCLUSIONS: In the private health insurance system, psychiatric illnesses have almost no rooms. It is very urgent to add space for patients with psychiatric illnesses and psychiatrists in the insurance policies.
Diagnosis ; Humans ; Insurance* ; Insurance, Health ; Korea* ; Medical Records ; Psychiatry

OBJECTIVES: This study was conducted to evaluate the reliability and the validity of the Korean version of the Scale to Assessment Unawareness of Mental Disorder (SUMD-K). METHODS: The subjects were 55 schizophrenic patients between ages of 26 and 58 who were recruited from the psychiatric unit of the university hospital and the out-patient clinic. The SUMD-K and insight scale of PANSS were applied to the patients. RESULTS: The range of inter-rater (Spearman's rho) of the general items of SUMD-K were .97-. 98 on the current illness and .58-.98 on the past illness. The correlation coefficient between the sum and the general items of the SUMD-K showed high scores. The concurrent validity between SUMD-K and insight item of PANSS was high (scores between .59-.96). However, the reliability and the validity of the attribution items of symptoms showed low scores compared to the current symptoms. CONCLUSION: The SUMD-K was confirmed in its reliability and validity. It can be a useful clinician-rating scale for evaluating insight in schizophrenic patients as well as patients with other neuropsychiatric conditions.
Humans ; Mental Disorders* ; Outpatients ; Reproducibility of Results*

Pulmonary gangrene is a rare and severe complication of bacterial pneumonia, where a pulmonary segment or lobe is sloughed due to parenchymal devitalization of the parenchyma, with secondary anaerobic infection and necrosis caused by pulmonary vascular thrombosis. Prior to the antibiotic era, massive pulmonary gangrene was potentially fatal. Herein, a case of pulmonary gangrene in a 67-year-old man is reported. He complained of fever, chills, dyspnea and purulent sputum of 5 days duration. The plain chest radiograph showed well-marginated right upper lobe consolidation, with bulging minor fissure, suggestive of a Klebsiella infection. A contrast CT scan demonstrated consolidation of the right upper lobe, with a central necrotizing portion. Klebsiella species was confirmed from both sputum and blood cultures. After appropriate antibiotics, the chest X-ray and CT scan 3 weeks later showed a large cavity with an air-fluid level, sloughing-off and extrusion of necrotic lung tissue, suggestive of pulmonary gangrene. Seven months later, the right gangrenous lung showed severe volume loss on a chest radiograph. The management of pulmonary gangrene has been somewhat controversial. Herein, it was managed without surgical drainage or resection. If the antibiotic therapy had failed, then a surgical approach would have been considered.
Aged ; Anti-Bacterial Agents ; Chills ; Drainage ; Dyspnea ; Fever ; Gangrene* ; Humans ; Klebsiella Infections ; Klebsiella* ; Lung ; Necrosis ; Pneumonia* ; Pneumonia, Bacterial ; Radiography, Thoracic ; Sputum ; Thorax ; Thrombosis ; Tomography, X-Ray Computed

Chemical pneumonitis is caused by the inhalation of noxious chemical substances and is a cause of occupational lung disease. Nitric acid, which is a one of the common air pollutants and a potential oxidant for refining and cleansing of metals, has a chance for occupational and environmental exposure. A 52-year-old man visited our hospital due to coughing and dyspnea after the inhalation of nitric acid fumes at his workplace. He had conditions of tachypnea (respiratory rate 26 /min) and hypoxemia (PaO2 42.6 mmHg, SaO2 80.2% in room air) in our emergency department. The chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient made improvements in clinical symptoms and chest radiography after being given a supply of oxygen, antibiotics, and bronchodilator therapy without systemic glucocorticoid therapy. On his follow up visit after 4 weeks, he showed no symptoms and sequelae, and the pulmonary function test showed a normal pulmonary function.
Air Pollutants ; Anoxia ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Emergency Service, Hospital ; Environmental Exposure ; Follow-Up Studies ; Glass ; Humans ; Inhalation* ; Lung ; Lung Diseases ; Metals ; Middle Aged ; Nitric Acid* ; Oxygen ; Pneumonia* ; Radiography ; Radiography, Thoracic ; Respiratory Function Tests ; Tachypnea ; Thorax

OBJECTIVES: We developed the short form of the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM-S), based on the concept of the mentalization. METHODS: The MIPAdo-CM was composed of 6 sessions and was applied to 133 students in the 1st grade of a middle school for six weeks during their regular school hours. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test, Peer Aggression Scale, Peer Bullying Scale, School Adjustment Scale, Test Anxiety Inventory and Visual Analogue Scale between the subject and the control group. RESULTS: On the Visual Analoge Scale, students in the trial classes reported an increased understanding and respect for others, as well as themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves. To prove objective usefulness of this program, further studies should be administered in the form of long-term, regular and structured courses.
Adolescent ; Aggression ; Bullying ; Child ; Empathy ; Humans ; Mental Health ; Test Anxiety Scale

OBJECTIVES: Understanding the emotions, thoughts, feelings and behaviors of others, as well as oneself, is part of the mentalizing function. We developed a new school-based community model for mental health, called the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM), based on the concept of mentalization. METHODS: The MIPAdo-CM was composed of 12 sessions and was applied to 403 students in the 2nd grade of a middle school. Every session was conducted after the regular school hours for 6 weeks. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test (EET), Peer Aggression Scale (PAS), Peer Bullying Scale (PBS), School Adjustment Scale (SAS), Test Anxiety Inventory (TAI) and Visual Analogue Scale between the subject and the control group. RESULTS: There was no significant difference between two groups in AMPQ-R, EET, PAS, PBS, SAS, and TAI. On the Visual Analoge Scale, however, students in the trial classes reported more increase in understanding and respect for both others and themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves, erence between two groups in AMPQ-R, Empathy test, To prove objective usefulness of this program, further studies with more structured design will be needed.
Adolescent ; Aggression ; Anxiety ; Bullying ; Child ; Empathy ; Humans ; Mental Health ; Phenothiazines ; Theory of Mind