The authors report a case of dexfromethorphan induced mood disorder with the review of literafures. The patient is a 19-year old female who had been taking dextromethorphan hydrobromide (trade name : romilar) for 14 month s to enjoy its pleasurable effects and to reduce anxiely. Acute intoxication symptoms of dextromethorphan hydrobromide were silly smiles, a euphoric feeling of floating and an optimistic mood. Tolerance developed and she had been taking 70 tablets (1050mg) ot maximum per day. Withdrawal symptoms were anxiely and its related symptoms and a craving for the drug. While taking 50 tagblets per day about 12 days prior to admission, she had developed leated and irritable mood. grandicstily and auditory hallucinations. These symptoms continued despite discontinuation of the drug after admission. the degree of elated and irritable patient's mood was prominent. flight of ideas was not so severe. However, there was prominent grandiosity and auditory hallucinations. She was treated with haloperidol and lithium and then showed gradual remission in 3weeks. If would necessary to explore any drug abuse history in psychiatric patients who are in their teens.
Adolescent ; Dextromethorphan* ; Female ; Hallucinations ; Haloperidol ; Humans ; Irritable Mood ; Lithium ; Mood Disorders* ; Substance Withdrawal Syndrome ; Substance-Related Disorders ; Tablets ; Young Adult

PURPOSE: To investigate the relationship between the smart devices usage-related factors and self-regulation ability development in early childhood. METHODS: Parental questionnaires of 187 children aged 3–6 years were analyzed. The metrics included smart device usage frequency (times/week, scored as uFreq), smart device usage time (hours/day, scored as uTime), parental scale for appropriate smart device usage level (scored as uLevel), the Korean-developmental screening test (K-DST), and the scale for self-regulation ability in young children (scored as SRS, and including four sub-categories: self-appraisal, self-determination, behavior inhibition, and emotionality). The correlations were analyzed by total age group and by each age. RESULTS: In the total age group analysis, uFreq and uTime were negatively correlated with mean SRS (rs =−0.366, −0.330; P < 0.001) and sub-category SRS (rs =−0.186 to −0.370; P < 0.05). Mean uLevel score was positively correlated with mean SRS (rs =0.406; P < 0.001) and most of the mean sub-category SRS (rs =0.174 to 0.362; P < 0.05). In 3-year-old children, the mean SRS was strongly negatively correlated with uFreq (rs =−0.751; P < 0.001), negatively correlated with uTime (rs =−0.518; P < 0.001), and positively correlated with mean uLevel score (rs =0.533; P=0.013). Such correlations seemed to decrease at the age of 4–6 years. CONCLUSION: Self-regulation ability was significantly correlated with smart device-related factors and was the highest in the 3-year-old children. Encouraging appropriate smart device usage will be helpful for self-regulation development of young children.
Child ; Child, Preschool ; Diagnostic Self Evaluation ; Humans ; Mass Screening ; Parents ; Self-Control* ; Smartphone

OBJECTIVE: The authors report the surgical results of anterior circulation aneurysm surgery by inexperienced neurosurgeon and the results are compared to those of experienced one. METHODS: The pterional approach for the anterior circulation aneurysm was performed on 20 cases from July 2000 to July 2001 by experienced neurosurgeon. The pterional approach and orbitozygomatic with orbital rim osteotomy were performed on 10 cases respectively from Oct 2001 to May 2002 by inexperienced neurosurgeon. RESULTS: All of aneurysms were treated by direct clipping. Good outcomes(Glasgow Outcome Scale score 4 or 5) were achieved in 60%, fair(GOS score 3) 10%, poor(GOS score 1 or 2) 30% through pterional approach by inexperienced neurosurgeon. Good outcomes were achieved in 70%, fair 20%, poor 10% through orbital rim or orbitozygomatic approach by inexperienced neurosurgeon. Good outcomes were achieved in 65%, fair 20%, poor 15% by experienced neurosurgeon. CONCLUSION: The clinical outcomes of anterior circulation aneurysmal surgery through the orbital rim or orbitozygomatic osteotomy by inexperienced neurosurgeon showed no statistical differences compared with routine pterional approach. However, the authors could obtain lesser brain retraction and easy access of the target through the orbital rim or orbitozygomatic osteotomy.
Aneurysm* ; Brain ; Orbit ; Osteotomy

OBJECTIVE: The purpose of this study was to evaluate the efficacy of PLIF using cages on the unstable level and additional instrumented posterolateral fusion in patients with multilevel lumbar degenerative disease with segmental instability. METHODS: Clinical and radiological outcomes including the rate of bony fusion and changes in disc height, translation, and angular displacement on PLIF level, and its complications were analyzed in 28 patients (male:female=8:20) who were observed for more than 2 years (mean 30.6 months) between 1998 and 2000. RESULTS: The rate of successful fusion was 93% (26 patients). Clinical outcomes according to Prolos's classification were revealed with excellent in 10 patients (36%), good in 14 patients (50%), fair in 3 patients (10%), and poor in 1 patient (4%). The mean disc height on the PLIF level (35 levels including 6 patients with 2 levels PLIF) was changed from 0.48+/-0.11, preoperatively to 0.66+/-0.08 at 2-year follow-up by Farfan method (P<0.05). Mean vertebral body translation was decreased from 7.52+/-2.74mm, to 1.07+/-1.33mm and mean angular displacement was corrected from 11.21+/-4.43 degree to 1.03+/-0.62 degree (P<0.05). Permanent complications were relatively minimal. CONCLUSION: Favorable outcomes were achieved in 86% with relatively low surgical morbidity rates. It can be concluded that PLIF using cages on unstable lumbar segment and additional instrumented posterolateral fusion method is an effective stabilizing method for the multilevel lumbar degenerative disease with segmental instability in spite of its technical demanding and long operation time.
Classification ; Follow-Up Studies ; Humans

OBJECTIVE: To characterize perioperative biomechanical changes after thoracic spine surgery. METHODS: Fifty-eight patients underwent spinal instrumented fusions and simple laminectomies on the thoracolumbar spine from April 2003 to October 2008. Patients were allocated to three groups; namely, the laminectomy without fusion group (group I, n = 17), the thoracolumbar fusion group (group II, n = 27), and the thoracic spine fusion group (group III, n = 14). Sagittal (ADS) and coronal (ADC) angles for adjacent segments were measured from two disc spaces above lesions at the upper margins, to two disc spaces below lesions at the lower margins. Sagittal (TLS) and coronal (TLC) angles of the thoracolumbar junction were measured from the lower margin of the 11th thoracic vertebra body to the upper margin of the 2nd lumbar vertebra body on plane radiographs. Adjacent segment disc heights and disc signal changes were determined using simple spinal examinations and by magnetic resonance imaging. Clinical outcome indices were determined using a visual analog scale. RESULTS: The three groups demonstrated statistically significant differences in terms of angle changes by ANOVA (p < 0.05). All angles in group I showed significantly smaller angles changes than in groups II and III by Turkey's multiple comparison analysis. Coronal Cobb's angles of the thoracolumbar spine (TLC) were not significantly different in the three groups. CONCLUSION: Postoperative sagittal balance is expected to change in the adjacent and thoracolumbar areas after thoracic spine fusion. However, its prevalence seems to be higher when the thoracolumbar spine is included in instrumented fusion.
Humans ; Laminectomy ; Magnetic Resonance Imaging ; Prevalence ; Spine

No abstract available.
Pancreas*

Anemia is common in patients with advanced chronic kidney disease (CKD). Though erythropoiesis-stimulating agents (ESAs) have been strongly endorsed in guidelines, it is of particular financial interest. Recently, the reimbursement of ESAs in non-dialytic patients was started by the Korean National Health Insurance System. Thus, we investigated the impact of the reimbursement of ESAs on the anemia care in non-dialytic CKD patients. Medical records of patients with advanced CKD (estimated GFR <30 mL/min/1.73 m2) were reviewed. Use of ESAs, blood transfusion, and hemoglobin concentrations were analyzed from one year prior to reimbursement to three years following. We used multivariable modified Poisson regression to estimate the utilization prevalence ratio (PRs). A total of 1,791 medical records were analyzed. The proportion of patients receiving ESAs increased from 14.8% before reimbursement to a peak 33.6% in 1 yr after reimbursement; thereafter, ESA use decreased to 22.4% in 3 yr after reimbursement (compared with baseline; PR, 2.19 [95% CI, 1.40-3.42]). In patients with Hb <10 g/dL, the proportion of receiving ESAs increased from 32.1% before reimbursement to 66.7% in 3 yr after reimbursement (compared with baseline; PR, 2.04 [95% CI, 1.25-3.32]). Mean hemoglobin concentrations were 10.06±1.54 g/dL before reimbursement and increased to 10.78±1.51 g/dL in 3 yr after the reimbursement change (P=0.001). However, the requirement of blood transfusion was not changed over time. With the reimbursement of ESAs, the advanced CKD patients were more likely to be treated with ESAs, and the hemoglobin concentrations increased.
Adolescent ; Adult ; Aged ; Anemia/complications/*drug therapy/epidemiology ; Blood Transfusion ; Female ; Glomerular Filtration Rate ; Hematinics/*therapeutic use ; Hematocrit ; Hemoglobins/analysis ; Humans ; Male ; Middle Aged ; National Health Programs ; Poisson Distribution ; Prevalence ; Renal Insufficiency, Chronic/complications/*drug therapy/epidemiology ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult

PURPOSE: We know little about the natural course of IgA nephropathy (IgAN) in association with histologic changes especially in children. We investigated clinicopathologic features with long-term follow-up biopsy to clarify the outcomes and prognostic indicators for childhood IgAN. METHODS: From our patients' medical records, we retrieved 20 patients with IgAN, to whom renal biopsies had been performed for the initial diagnosis and follow-up to find out any histologic changes. Initial and follow-up biopsies were classified by Haas classification. The changes of these parameters were compared with the evolution of clinical features. RESULTS: Patients were treated with angiotensin-converting enzyme inhibitors in combination with angiotensin receptor blockers (in subclass II or above) and short-term cyclosporine A(in patients showing nephrotic syndrome). Histologic improvement in 7 cases and deterioration in 3 cases were observed. At the time of last biopsy, 10 cases (50%) showed clinical remission and the others showed improved clinical features. These clinical outcomes did not correlate with initial Haas classifications. Hypertension at onset observed in 5 cases (25%) revealed significant correlation with clinical outcome (P=0.01) and last Haas classification (P=0.007). None of the cases showed progression to CRF or ESRD. CONCLUSION: During a mean follow-up of 10.8+/-3.4 years, childhood IgAN showed good clinicopathologic outcome. Hypertension at onset was only a strong predictor of clinicopathologic outcomes, but initial Haas classification cannot predict outcomes in children. Histologic change of IgAN in long term follow-up period cannot be completely predicted by clinical data and vice versa. Therefore, a renal biopsy should be considered as a part of follow-up plan.
Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Biopsy ; Child ; Cyclosporine ; Follow-Up Studies ; Glomerulonephritis, IGA ; Humans ; Hypertension ; Immunoglobulin A ; Medical Records ; Prognosis

BACKGROUND: Recently, many surgeons have chosen sublobar resection for the curative treatment of lung tumors with ground-glass opacity, which is a hallmark of lepidic lung cancer. The purpose of this study was to evaluate the oncological results of sublobar resection for non-lepidic lung cancer in comparison with lobectomy. METHODS: We conducted a retrospective chart review of 328 patients with clinical N0 non-small cell lung cancer sized ≤2 cm who underwent curative surgical resection from January 2009 to December 2014. The patients were classified on the basis of their lesions into non-lepidic and lepidic groups. The survival rates following lobectomy and sublobar resection were compared within each of these 2 groups. RESULTS: The non-lepidic group contained a total of 191 patients. The 5-year recurrence-free survival rate was not significantly different between patients who received sublobar resection or lobectomy in the non-lepidic group (80.1% vs. 79.2%, p=0.822) or in the lepidic group (100% vs. 97.4%, p=0.283). Multivariate analysis indicated that only lymphatic invasion was a significant risk factor for recurrence in the non-lepidic group. Sublobar resection was not a risk factor for recurrence in the non-lepidic group. CONCLUSION: The oncological outcomes of sublobar resection and lobectomy in small-sized non-small cell lung cancer did not significantly differ according to histological type.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Surgeons ; Survival Rate ; Thoracic Surgery

We report a case of congenital renal arteriovenous malformation in which painless gross hematuria was the only clinical manifestation.
Arteriovenous Malformations* ; Hematuria ; Kidney*