Objective: The Delirium Diagnostic Tool-Provisional (DDT-Pro) was designed to detect the presence and severity of delirium briefly and objectively regardless of psychiatric expertise. We translated the DDT-Pro into Korean and validated it in elderly Korean patients. Methods: To validate the translation and evaluate inter-rater reliability, a psychiatric trainee and a research nurse independently assessed the same patients referred to the Department of Psychiatry. The results were compared with the reference evaluations performed by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Results: We enrolled 42 elderly patients. The Cronbach’s alpha coefficient were 0.839 (the trainee), 0.822 (the nurse). The Cohen’s weighted κ between the trainee and nurse, ranged from 0.555±0.102 to 0.776±0.062. The Pearson correlation coefficients (Korean version of the DDT-Pro [K-DDT-Pro] and Korean version of the Delirium Rating Scale-Revised-98 [DRS-R98-K] total score) were γ=-0.850 (the trainee), and γ=-0.821 (the nurse). The areas under the ROC curves (AUCs) were 0.974 (the trainee) and 0.893 (the nurse). Conclusion The K-DDT-Pro exhibited high internal consistency and relatively substantial inter-rater reliability. The correlation with the DRS-R98-K was strongly negative. The accuracy of the K-DDT-Pro was excellent, regardless of expertise. In conclusion, the K-DDT-Pro is a brief and simple tool that usefully screens for delirium in elderly patients.

Tetanus is a neurologic disorder caused by a tetanospasmin released from Clostridium tetani and usually occurs following a stab wound or dirty abrasion. Tetanus is uncommon in Korea due to the introduction of vaccination programs. Furthermore, tetanus associated with a gangrenous perforation of the small bowel is extremely rare. We report a case of tetanus developed in a patient who was diagnosed with a gangrenous perforation of the small bowel. This is the first reported case in Korea.
Clostridium tetani ; Digestive System Surgical Procedures ; Humans ; Intestinal Perforation ; Korea ; Metalloendopeptidases ; Nervous System Diseases ; Tetanus ; Tetanus Toxin ; Vaccination ; Wounds, Stab

BACKGROUND: Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.
Alveolitis, Extrinsic Allergic* ; Arthritis, Rheumatoid ; Cryptogenic Organizing Pneumonia ; Granuloma ; Humans ; Hypersensitivity* ; Korea ; Lung Diseases ; Lung Diseases, Interstitial ; Lung Injury ; Lymphoma, Non-Hodgkin ; Methotrexate* ; Osteosarcoma ; Pneumonia ; Psoriasis ; Sarcoidosis ; Wegener Granulomatosis

BACKGROUND: Sputum smears for acid-fast bacilli(AFB) examined microscopically is the most important diagnostic test for pulmonary tuberculosis. However, the AFB observed on the smear may represent either M. tuberculosis or nontuberculous mycobacteria(NTM). This study examined the recovery rate of NTM from the AFB smear-positive sputum specimens in a tertiary hospital in Korea. MATERIALS AND METHODS: This study analyzed the results for the 1,889 AFB smear-positive and culture-positive sputum specimens collected from 844 patients from July, 1997 to December, 2001. RESULTS: The 1,889 sputum specimens collected from 844 patients tested positive on both microscopy and culture during the 4.5 years. The NTM were recovered from 10.3%(195/1,889) of the smear-positive sputum specimens and 11.0%(93/844) of patients with smear-positive sputum. The NTM were isolated more than two times in 44.1%(41/93) of the patients from whom the NTM was recovered. Trends of the recovery rate of the NTM from the AFB smear-positive sputum specimens were increasing from 6.5%(17/262) in the latter half of 1997 to 17.8%(36/202) in the latter half of 2001 (p<0.001, test for trend). CONCLUSIONS: These results suggest that some patients with AFB smear-positive sputum have NTM pulmonary disease rather than pulmonary tuberculosis in Korea.
Diagnostic Tests, Routine ; Humans ; Korea ; Lung Diseases ; Microscopy ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria* ; Sputum* ; Tertiary Care Centers ; Tuberculosis ; Tuberculosis, Pulmonary

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.
Humans ; Immunocompetence ; Immunocompromised Host ; Infarction ; Male ; Mucormycosis ; Pneumonia ; Shock, Septic

PURPOSE: The purpose of this study was to investigate the usefulness of the ultrasonography as a screening test for thyroid diseases. MATERIALS AND METHODS: For 7 months, thyroid ultrasonography (7.5 MHz linear array) was performed prospectively by radiologists on 1,316 subjects who do not have a history of the thyroid disease. We analyzed the morphological abnormalities of thyroid gland and these were classified as the nodulal, cystic and diffuse types in accordance with the gender and ages of the patients. We performed ultrasound-guided fine needle aspiration in 21 patients who had sonographic features that were suggestive of malignant thyroid nodules. Physical examination was performed for all subjects by clinicians before the thyroid ultrasonography, and we compared the detectability of thyroid lesions between ultrasonography and physical examination. RESULTS: Thyroidal abnormalities were detected in 94 (7.1%) of 1,316 subjects. Among the 94 patients, 72 (5.5%) showed as nodules, 18 (1.4%) showed as cysts and 4 (0.3%) showed as diffuse abnormalities. The result of the ultrasound-guided aspiration on 21 patient showed 4 malignant nodules, 16 benign nodules and 1 undetermined nodule. Physical examination detected abnormalities in only 12 patients (12.8%) of the 94 patients, which were showed as nodules, cysts and the diffuse type by ultrasonography. CONCLUSION: Thyroid disease of the general population was relatively common and the detection rate with performing physical examination for the thyroid nodule, cyst and the diffuse type was lower than that for ultrasonography. Thyroid ultrasonography is a useful screening modality for detecting thyroid diseases.
Biopsy, Fine-Needle ; Early Detection of Cancer ; Humans ; Mass Screening* ; Physical Examination ; Prospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography*