Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Diagnosis ; Epidural Abscess* ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Myelitis* ; Neck ; Paresis ; Sensation ; Spinal Cord ; Spine

OBJECTIVES: OSAS (obstructive sleep apnea syndrome) is a common disorder and its consequences are often serious. It is important to detect the disorder early in the course for proper treatment. This study is to grasp the snoring clinic visitors' knowledge level of OSAS. METHODS: One hundred and seventy-nine visitors at the of snoring clinic of Seoul National University Hospital were surveyed by questionnaire about reasons of visit and knowledge of treatment methods of snoring and OSAS, diagnostic method, OSAS-related symptoms, and complications. RESULTS: Most of the respondents (89.4%) "have already heard about OSAS" and the major sources of information was the mass media (58.1%) such as television and radio. More than half (60.3%) were aware that snoring is closely related to OSAS. More than half (59.8%) recognized that a nocturnal polysomnograpy was necessary for proper diagnosis. Two thirds (67%) of the respondents noted surgery as a treatment for snoring. More than half (55.9%) answered that they would follow the doctor's advice on the treatment choice. Only 12.3% of respondents "have heard about nCPAP". No one chose nCPAP (nasal continuous positive airway pressure) as a treatment for either snoring or OSAS. About one third (34.6%) of the respondents were aware that OSAS is related to hypertension. Only 12.8% noted that OSAS is related to diabetes mellitus. CONCLUSION: Visitors at the snoring clinic were found to have substantially limited knowledge of health risks and proper treatments of OSAS. We suggest that it is crucially important to educate patients and offer easy-to-understand information on snoring and OSAS. We predict that provision of educaiton and information to patients and general public will faciliate the diagnosis and treatment of snoring and OSAS and reduce the related disorders such as hypertension, stroke, and diabetes mellitus.
Diabetes Mellitus ; Hand Strength ; Humans ; Hypertension ; Mass Media ; Surveys and Questionnaires ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Stroke ; Television

Hypematremia is a rare but important medical condition and is associated with mortality rate of 40 to 70%. However, little has been known about its prognostic factors or treatment guidlines. To evaluate the prognostic factors and the outcome following treatment, we reviewed 22 available medical records among twenty five hypernatremic patients (0.2%) in 12841 admissions at medical ward from January to December 1995. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Of these patients, two had hypematrernia at admission and the remaining patients became hypernatremic during admission. Mean peak serum sodium concentration was 158 (150-178) mEq/L and mean total body water deficit was 11.4 (6.7-21.3)%. Factors correlated with the development of hypernatremia were diverse and multiple, and the most frequent factor was diminished access to water. Mortality rate was 59%, but mortality was not correlated with age, correction rate of hyper-natremia, primary route of fluid loss, and the severity of hypernatremia or total body water deficit. Mortality rate was higher in patients whose serum sodium concentrations were below 130 mEq/L at admission (P<0.05). In our study, development of hypernatremia from initial hyponatremic state was significantly associated with poor outcome, and age, rapidity of correction, route of fluid loss, and the severity of hypernatremia or total body water deficit were not.
Body Water ; Humans ; Hypernatremia* ; Medical Records ; Mortality ; Sodium ; Water

OBJECTIVES: This study investigated the differences between the psychiatric characteristics of minor juvenile offenders and normal adolescents as well as differences in psychiatric symptoms after a six month protective disposition. Further, the current study aimed at determining psychiatric screening methods for evaluating delinquent adolescents. METHODS: The Latent Delinquency Questionnaire (LDQ), the Revised Children's Manifest Anxiety Scale (RCMAS), the Children's Depression Inventory (CDI), the Reynolds Suicidal Ideation Questionnaire (SIQ), the Piers-Harris Children's Self Concept Inventory (SCI), and the Korean Youth Self Report (K-YSR) were administered to 134 normal adolescents (114 males) and 109 minor offenders (97 males) aged 12 to 16 years. After six months, 46 offenders (all males) completed the RCMAS, CDI, SIQ, and SCI again. RESULTS: Adolescents with minor offenses had more delinquent, aggressive behavior and externalizing behavior problems, but were significantly less depressive, anxious, or suicidal than normal controls. Further, recidivists had more anxiety, depression, and delinquent behavior than non-recidivists. Minor offenders reported that their anxiety and depressive mood decreased after six months of protective disposition. CONCLUSION: Adolescents with minor offenses had more delinquent, aggressive behavior and externalizing behavior problems suggesting that psychiatric screening tools for minor offenders should measure disruptive behavior disorder.
Adolescent ; Aged ; Anxiety ; Attention Deficit and Disruptive Behavior Disorders ; Criminals ; Depression ; Follow-Up Studies ; Humans ; Manifest Anxiety Scale ; Mass Screening ; Self Concept ; Self Report ; Suicidal Ideation ; Surveys and Questionnaires

OBJECTIVE: Adolescence is a period of developing emotional regulation. However, alexithymia has rarely been examined during this period. The objective of this study is to examine the factor structure and internal consistency of the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K) in normal adolescents in South Korea. METHODS: The TAS-20K was administered to a sample of 290 adolescents aged from 12 to 16 years old. Internal reliability, test-retest reliability, and factorial validity were evaluated. RESULTS: The three factors of the TAS-20K were confirmed by confirmatory factor analysis. The internal consistency, measured using Cronbach's alpha coefficient was acceptable for difficulty in identifying feelings, good for difficulty in describing feelings, and acceptable for externally oriented thinking. CONCLUSION: Our study indicates that the TAS-20K is an appropriate instrument to assess alexithymia in Korean adolescents.
Adolescent ; Affective Symptoms ; Aged ; Humans ; Reproducibility of Results ; Republic of Korea ; Thinking

Sarcoma of the uterus is very rare malignant tumor arising from the muscle or connective tissue, and there are only a few cases reported in Korea. We have experienced 16 cases of uterine sarcomas for 10 years from 1986 to 1995. The results are as follows: 1. The incidence of uterine sarcomas in uterine leiomyomas was estimated to 0.69%. 2. The pathologic types were 5 cases(31.3%) of leiomyosarcoma, 3 cases(18.8%) of endometrial stromal sarcoma, 6 cases(37.5%) of malignant mixed Mllerian tumor 2 cases(12.5%) of rhabdomyosarcoma in order. 3. The mean age was 46.4 years. 4. Seven(58.7%) were stage I, 2(16.7%) were stage III, and 3(25.6%) were stage IV. 4. The chief complaints on admission were abdominal mass(50%), abnormal bleeding(25%), and pelvic or abdominal pain(25%). 5. The estimated median survival was 43 months, and there was no correlation between survival and number of mitotic figure per 10 high power fields, stages, or radiation therapy.
Connective Tissue ; Incidence ; Korea ; Leiomyoma ; Leiomyosarcoma ; Prognosis ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Endometrial Stromal ; Uterus

A 71-year-old man with a history of percutaneous transluminal coronary angioplasty(PTCA) was referred to our clinic with a one-day history of a continuous substernal chest pain radiating to his left shoulder. In retrospect, he experien- ced chest discomfort after eating fish one day before but did not seek medical attention then. An upper gastrointestinal endoscopy was performed. The cause was not visible during the advancement of the endoscope through the eso- phagus, but a small segment of a fish bone protruding from an ulcerative lesion in the lower esophagus was iden- tified while withdrawing the endoscope. The fishbone was immediately removed. A follow-up CT scan revealed pneumo- mediastinum. Now hemodynamically stable, the patient underwent conservative medical treatment including total parenteral nutrition(TPN) and intravenous antibiotic drugs. The patient made complete recovery. We report a case of a 71- year-old male found to have an esophageal perforation from an ingested fish bone, which was managed successfully with conservative treatment. A pertinent literature review is also included.
Aged ; Chest Pain ; Eating ; Endoscopes ; Endoscopy, Gastrointestinal ; Esophageal Perforation ; Esophagus ; Follow-Up Studies ; Foreign Bodies ; Humans ; Male ; Mediastinitis ; Mediastinum ; Shoulder ; Thorax ; Ulcer

Mineralocorticoids influences on acid-base homeostasis by the regulation of urine acidification. But its mechanism of acion is not well known in human. This study compared the acid-base status and the indices of urine acidification before and after mineralocorticoid administration in human, and analyzed the effect of mineralocorticoids on human acid-base homeostasis. We administered 9a-fludrocortisone in 6 chronic renal failure patients and 6 normal controls 0.5mg daily for 7 days. The results were as following: 1) After administration of 9a-fludrocortisone in patients group, serum aldosterone level changed from 120.2+/-71.0pg/mL to 44.8+/-32.2pg/mL(mean+/-SD, p< 0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 24.6+/-12.3 mmol/day to 43.7+/-19.0 (p<0.05), but there were no change in urine pH and urine anion gap, Serum potassium level decreased from 5.5+/-0.7mBq/L to 4.1+/-0.5mEq/L (p<0.05), and TTKG increased from 3.9 to 8.9(p<0.05). 2) After administration of 9a-fludrocortisone in control group, serum aldosterone level changed from 99.7+/-44.5pg/mL to 25.1+/-3 mL(p<0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 44.3+/-21.6mmoVday to 76.3+/-19.6(p<0.05), but there were no change in urine pH and urine anion gap. Serum potassium level decreased from 4.8+/-0.5mEq/L to 3.9+/-0.2mHq/L(p< 0.05), but there was no change in TTKG. 3) No patient or control showed any discomfort after 9-fludrocortisone administration, and there was no elevation in diastolic blood pressure, increase in body weight, electrolyte abnormality. In summary, after 9alpha-fludrocortisane administration, urinary ammonium excretion increased in both patients and control group, and this phenomenon occured with correction of hyperkalemia without urine pH change. This result implies urinary ammonium excretion increase by mineralocorticoid. In human increase in renal distal acidification by mineralocorticoid is due to increase in renal ammoniagenesis rather than stimulation on proton excretion.
Acid-Base Equilibrium ; Aldosterone ; Ammonium Compounds* ; Blood Pressure ; Body Weight ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Kidney Failure, Chronic ; Mineralocorticoids ; Potassium* ; Protons

Alcohol can cause rhabdomyolysis by either direct toxicity or associated metabolic abnormality such as hypophosphatemia and hypokalemia. It can also predispose to or cause trauma, seizures, or coma- induced ischemic pressure necrosis. In order to investigate the clinical features of acute renal failure caused by alcohol induced rhabdomyolysis, we reviewed the medical records of the 12 patients. All patients had been drinking much amounts of alcohol for several years. All patients showed elevation of muscle enzyme such as creatine phosphokinase, lactic dehydrogenase, aspartate transaminase and blood urea nitrogen and serum creatinine. Predisposing factors of rhabdomyolysis were ischemic compression due to unconsciousness and dehydration(2 cases), and hypophosphatemia and dehydration(1 case), seizure and dehydration(1 case), and only severe dehydration(3 cases). Initial symptoms were painful swelling at lesion site(5 cases), abdominal pain(2 cases), general ache(2 cases), leg pain without swelling(1 case), dyspnea(1case), and lethargy(1 case). Seven patients developed delirium tremens during recovery stage. Eight patients showed oliguric acute renal failure and 8 patients were treated with hemodialysis. Complications were disseminated intravascular coagulation(DIC)(3 cases), compartment syndrome(2 cases), capillary leak syndrome and DIC(1 case). One of 12 patients died of disseminated intravascular coagulation and other patients showed complete recovery of renal function.
Acidosis* ; Acute Kidney Injury ; Alcohol Withdrawal Delirium ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Capillary Leak Syndrome ; Causality ; Creatine Kinase ; Creatinine ; Disseminated Intravascular Coagulation ; Drinking ; Humans ; Hypokalemia ; Hypophosphatemia ; Leg ; Medical Records ; Necrosis ; Oxidoreductases ; Renal Dialysis ; Rhabdomyolysis ; Seizures ; Unconsciousness

Mood stabilizers and atypical antipsychotics are commonly combined for the treatment of bipolar mania. The aim of this study was to compare the effectiveness and tolerability of topiramate and divalproex in combination with risperidone for treating acute mania patients in a naturalistic treatment setting. Seventy-four patients who met the DSM-IV criteria for bipolar mania were enrolled in this study. In order to assess the efficacy and the extrapyramidal symptoms, the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale were measured at the baseline and at weeks 1, 3 and 6. From the baseline to the endpoint, the YMRS and CGI scores were reduced by 67.9% and 56.6% in the topiramate group. The YMRS and CGI scores were also reduced by 63.7% and 58.2% in the divalproex group. The weight and BMI increased significantly by 3.6% and 3.3% from the baseline to the endpoint in the divalproex group, while they decreased by 0.4% and 0.5%, respectively, with no significant difference in the topiramate group. There were no serious adverse events in either group. Topiramate is effective and tolerable for treating acute mania, and may also be a promising alternative to a weightgain liable mood stabilizer such as divalproex.
Antipsychotic Agents ; Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Risperidone ; Valproic Acid*