A Total of 498 cases of hemophilia which were reported by sixteen medical centers in Korea were reviewed and analyzed. Hemophilia A comprised 425 cases (85.3%) and the remaining 73 cases (14.7%) were hemophilia B. One case was female and all other cases were male. There were known hemophilia patients in the family in 43.0% of cases and the involved members were brothers, maternal cousins, maternal uncles, and maternal grandfathers in descending order of frequency. The major symptoms of the patients were hemorrhagic, such as easy bruising and hemarthrosis followed by prolonged bleeding after trauma and soft tissue hematoma. The incidence of hemarthrosis increased significantly with age. The pediatric age group below the age of 15 consisted of 67.1% of the cases. According to the age at diagnosis, half (54.2%) of the severe cases were diagnosed before the age of 1 year. APTT was prolonged over 40 seconds in all cases and 291 cases showed severe prolongation over 80 seconds. Of 498 cases 273 cases (54.8%) belonged to the severe form (factor VII or IX level, less then 1%), whereas 182 cases (36.5%) and 43 cases (8.7%) belonged to the moderate (factor VIII or IX, 2-5%) and mild form (factor VIII or IX, 6-25%), respectively, Chronic arthropathy was present in 236 cases (49.6%), and the incidence increased significantly with age. The management of chronic arthropathy most commonly employed was rehabilitation in 25.4% of cases, but in 50.8% no management was given at all. The involved joints in descending order of frequency were knees, elbows and ankles. The complications were intracranial hemorrhage, Gl bleeding and nerve palsy in 48, 24, and 13 cases, respectively.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; HIV Antibodies/immunology ; Hemophilia A/complications/*epidemiology/genetics ; Hemophilia B/complications/*epidemiology/genetics ; Humans ; Infant ; Joint Diseases/*etiology ; Male ; Questionnaires

A Total of 498 cases of hemophilia which were reported by sixteen medical centers in Korea were reviewed and analyzed. Hemophilia A comprised 425 cases (85.3%) and the remaining 73 cases (14.7%) were hemophilia B. One case was female and all other cases were male. There were known hemophilia patients in the family in 43.0% of cases and the involved members were brothers, maternal cousins, maternal uncles, and maternal grandfathers in descending order of frequency. The major symptoms of the patients were hemorrhagic, such as easy bruising and hemarthrosis followed by prolonged bleeding after trauma and soft tissue hematoma. The incidence of hemarthrosis increased significantly with age. The pediatric age group below the age of 15 consisted of 67.1% of the cases. According to the age at diagnosis, half (54.2%) of the severe cases were diagnosed before the age of 1 year. APTT was prolonged over 40 seconds in all cases and 291 cases showed severe prolongation over 80 seconds. Of 498 cases 273 cases (54.8%) belonged to the severe form (factor VII or IX level, less then 1%), whereas 182 cases (36.5%) and 43 cases (8.7%) belonged to the moderate (factor VIII or IX, 2-5%) and mild form (factor VIII or IX, 6-25%), respectively, Chronic arthropathy was present in 236 cases (49.6%), and the incidence increased significantly with age. The management of chronic arthropathy most commonly employed was rehabilitation in 25.4% of cases, but in 50.8% no management was given at all. The involved joints in descending order of frequency were knees, elbows and ankles. The complications were intracranial hemorrhage, Gl bleeding and nerve palsy in 48, 24, and 13 cases, respectively.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; HIV Antibodies/immunology ; Hemophilia A/complications/*epidemiology/genetics ; Hemophilia B/complications/*epidemiology/genetics ; Humans ; Infant ; Joint Diseases/*etiology ; Male ; Questionnaires

In thirty patients with acute leukemia and severe aplastic anemia receiving random single donor platelet transfusions, the development of refractoriness by consecutive platelet transfusions with cytapheresis and its relationship to the appearance of anti-platelet antibodies were investigated. The median number of platelet transfusions inducing refractoriness was 13 times, and 20% of the patients remained unrefractory despite of the repeated multiple platelet transfusions up to 20 to 25 times. The results of anti-platelet antibody tasts by the enzyme-linked immunosorbent assay(ELISA) and immunofluorescent techniques(IFT) showed no statistically significant relationship with the refractoriness (p greater than 0.1). Although there was significant correlation between the results of ELISA and IFT, both tests were insufficient to find out refractoriness even with the use of pooled platelets from multiple donors as target cells. This study shows that 13 single donor platelet transfusions result in refractoriness, that both ELISA and IFT are insufficient to detect refractoriness despite of their significant correlation, and that other methods than these are needed in order to detect alloimmunization.
Adolescent ; Adult ; Aged ; Anemia, Aplastic/therapy ; Anemia, Refractory/*etiology ; Antibodies/metabolism ; *Blood Platelets/immunology ; *Blood Transfusion ; Female ; Humans ; Leukemia/therapy ; Male ; Middle Aged

We report a rare case of thyroid metastasis from early gastric cancer with lymph node metastasis in a 63-yr old woman. She was diagnosed with metastatic adenocarcinoma one and a half years after distal subtotal gastrectomy, by fine needle aspiration (FNA) using thyroid sonography. Thyroid metastasis from gastric cancer is extremely rare, and this case is particular in that it is the first report of thyroid metastasis from early gastric cancer.
*Adenocarcinoma/pathology/secondary ; Biopsy, Fine-Needle ; Fatal Outcome ; Female ; Humans ; Lymphatic Metastasis/*pathology ; Middle Aged ; Stomach Neoplasms/*pathology ; Thyroid Neoplasms/pathology/*secondary

OBJECTIVE: It is well-known that antipsychotics are widely used in the treatment of bipolar disorder. So, the aim of this study was to examine the subjective response to antipsychotics in acute manic patients. METHODS: Data were gathered through the study for feasibility testing of Korean Medication Algorithm for Bipolar Disorder (KAMP-BP), which 17 nationwide clinical centers were entered into the study. A total 126 bipolar patients were enrolled and then 92 were treated according to the treatment algorithm. The data of 58 patients were completely recorded from baseline to 2 weeks of treatment and were entered into analysis. Drug Attitude Inventory-10 (DAI-10) was used for evaluating patient's subjective response to antipsychotics and patients were grouped as subjective non-dysphoric and dysphoric as the total score of DAI-10. For assessing the clinical status, Young Mania Rating Scale (YMRS), Clinical Global Impression- Severity scale (CGI-S), Hamilton Rating Scale for Depression (HAM-D), Global Assessment of Functioning (GAF) and Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) were used. RESULTS: Dysphoric group was younger and has more females in sex distribution than non-dysphoric group. YMRS and CGI-S were severer in dysphoric group. The prescription patterns were not different between two groups: Combinations of mood stabilizers and antipsychotics were administered to all patients and atypical antipsychotics were prescribed over 90% of the patients. At 2 weeks of treatment, more patients were turned into remission in non-dysphoric group. Dysphoric patients showed more changes of positive subjective response in DAI-10 from baseline and more patients turned toward the non-dysphoric group. CONCLUSION: Although the subjective response to antipsychotics using DAI-10 was not typically characterized in acute manic patients, it seems that atypical antipsychotics may have a role in determining the subjective feelings of the acute bipolar manic patients.
Antipsychotic Agents* ; Bipolar Disorder ; Depression ; Female ; Humans ; Prescriptions ; Sex Distribution

BACKGROUND AND OBJECTIVES: This study was designed to evaluate relation between frequencies of noise and tinnitus in noise-induced hearing loss and to elucidate mechanism of tinnitus in noise-induced hearing loss. MATERIALS AND METHODS: Four factories were selected, of which noise frequencies were different except one factory. Preliminary screening hearing test with a pure tone audiometer on 1000 and 4000 Hz was done. And if the hearing threshold was over 40 dB, history taking, otological examination, tympanometry, pure tone audiometry on 500, 1000, 2000, 4000, 6000 Hz were done. Noise was measured in 125, 250, 500, 1000, 2000, 4000, 8000 Hz. Tinnitus was measured using 1000, 2000, 4000 Hz pure tone. RESULTS: 1) Hearing loss was most severe in the 4000, 6000 Hz range. 2) In A factory, noise was most intense on 4000 Hz, in B factory on 2000 Hz, and in C and D factory on 1000 Hz. 3) Forty-three workers (42.2%) of total 102 subjects complained tinnitus. And frequency of tinnitus was 4000 Hz in 71 ears (89.9%) among 79 ears with tinnius. CONCLUSION: Regardless of the frequency of noise, most workers complain of 4 kHz tinnitus. And it was in accord with frequency of most severe hearing loss in the noise-induced hearing loss.
Acoustic Impedance Tests ; Audiometry ; Ear ; Hearing ; Hearing Loss ; Hearing Loss, Noise-Induced* ; Hearing Tests ; Mass Screening ; Noise* ; Tinnitus*

OBJECTIVE: The Korean College of Neuro psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) in clinical settings in Korea. METHODS: A total of 126 bipolar patients were enrolled at 17 centers. Among them, 92 patients were treated according to the algorithm. All subjects were assessed over a 4-month period. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. RESULTS: Overall ratings were favorable, with investigators stating that the overall quality of this algorithm was "good" or "no need to revise". Of manic patients, the majority (79%) showed treatment response (YMRS improvement > or =50%) at the first stage. CONCLUSION: These results suggest that this algorithm can be useful in clinical practices. However, some problems should be solved in the next version of KMAP-BP.
Bipolar Disorder ; Humans ; Korea ; Psychopharmacology ; Research Personnel ; Schizophrenia

Late stent thrombosis is one of the most serious complications associated with morbidity and mortality after coronary drug-eluting stent implantation, and is mainly caused by the withdrawal of antiplatelet agents. We report our experience of late stent thrombosis simultaneously involving three different coronary arteries in a young male patient who was treated with three drug-eluting stents two years ago. The patient stopped taking antiplatelet agents for several days. The patient did not recover from cardiogenic shock, even after repeated ballooning with thrombus aspiration, intra-aortic balloon pumping, and temporary pacing during cardiopulmonary resuscitation.
Blood Platelets ; Cardiopulmonary Resuscitation ; Coronary Vessels ; Drug-Eluting Stents ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Platelet Aggregation Inhibitors ; Shock, Cardiogenic ; Stents ; Thrombosis

OBJECTIVE: In the last decade, a number of pharmacological agents have shown efficacy in the treatment of bipolar disorder. Traditionally, lithium has been considered as the treatment of choice of bipolar disorder. However, more recently, atypical antipsychotics and newly developed anticonvulsants have become increasingly popular alternatives to lithium. This study examined the prescribing patterns for medications to treat bipolar disorder in office-based psychiatric practice. METHODS: The data for the present study were collected by using structured record form from November 2005 to December 2005. Psychotropic medications were grouped into six categories ; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Prescription data of 700 cases with a diagnosis of bipolar disorder according to DSM-IV from 70 Korean psychiatrists were accessed. Severity, mood episode, psychiatric comorbidity and point of diagnosis related utilization rates were computed focusing on atypical antipsychotics. RESULTS: In 695 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 62.4% of subjects, anticonvulsants in 58.7%, lithium in 47.8%, antidepressants in 17.6%, and typical antipsychotics in 15.5% of subjects. About seventeen percent of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Lithium and typical antipsychotics prescription were less frequent in depressive subjects than subjects with other mood episodes. Prescription of atypical antipsychotics and antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications. CONCLUSION: The rapid progress of psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

OBJECTIVE: Since the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision of treatment algorithm due to rapid progress in the management for bipolar disorder. We focused on the maintenance treatment of bipolar I and bipolar II disorders of KMAP-BP revised in 2006. METHOD: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 70 experienced psychiatrists. It was composed of 37 questions, and each question includes various sub-items. We classified the expert opinion to 3 categories (the first-line treatment, the second-line, the third-line) by x2 test. A part of this revision regarding maintenance treatment had 6 items ; 2 on bipolar I and 4 on bipolar II disorder. RESULTS: There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, mood stabilizer (MS) monotherapy was 1st-line treatment. In maintenance management for bipolar II disorder, two treatment options were recommended. Treatment with MS alone or combinations of MS and atypical antipsychotics were preferred in recently recovered patients from hypomania. Atypical antipsychotics were more favored in the maintenance treatment for bipolar I and II disorders than previous KMAP-BP. CONCLUSIONS: There is no 'treatment of choice' in maintenance strategies for bipolar disorder. Atypical antipsychotics are more preferred than the previous KMAP-BP. Also there is an increasing interest on the maintenance use of lamotrigine in bipolar depression.