PURPOSE: This descriptive study was conducted to identify the level of knowledge of stroke symptoms and risk factors among older adults. METHODS: A total of 200 older adults over 65 years of age were conveniently recruited from out patient departments of two hospitals and a health care center from October to November 2008. The level of knowledge was assessed using both open-ended questions and a structured questionnaire based on semi-structured interviews. Data were analyzed by t-tests and ANOVA using the SPSS program. RESULTS: 52.5% of the sample had hypertension and 30% had diabetes. The mean knowledge scores for symptoms and risk factors were 8.4 +/- 3.1(out of 15) and 9.5 +/- 3.9 (out of 16), respectively. The older adults who had lower education, lower family income, and who lived in rural areas were more likely to have less knowledge of stroke symptom and risk factors(p < .05). There was no significant knowledge difference between the older adults who had at least one risk factor and those who had no risk factor for stroke. CONCLUSIONS: Educational intervention should be focused on informing older adults who are at risk for stroke about the early symptoms and management of risk factors, especially those who have low education and low social status.
Adult ; Delivery of Health Care ; Humans ; Hypertension ; Risk Factors ; Stroke ; Surveys and Questionnaires

Ki-1 monoclonal antibody is a well known marker for Reed-Sternberg cells in Hodgkin's disease, but also occasionally reacts with activated lymphoid cells of either benign or malignant nature. Recently, Ki-1 antibody positive Non-Hodgkin's lymphoma, usually of large cell and/or polymorphous type, has been reported in the lymph nodes, skin, soft tissue, and stomach, but not in the bone. We report a case of multifocal primary bone lymphoma in a seven-year old body involving the left shoulder and right frontal bone, which proved to be a large cell, polymorphous lymphoma, helper T-cell type expressing Ki-1 antigen.
Child ; Male ; Female ; Humans

OBJECTIVES: Apathy Evaluation Scale (AES) is one of the most frequently used scales to evaluate apathy. The purpose of this study was to evaluate the reliability and validity of the Korean version of the AES (K-AES) and to apply the K-AES in examining the characteristics of apathy in the Korean patients with schizophrenia. METHODS: 129 healthy people and 29 patients with schizophrenia have been evaluated using the K-AES, Physical Anhedonia Scale (PAS), Social Anhedonia Scale (SAS), and the Beck's Depression Inventory (BDI). Split-half reliability and internal consistency were evaluated and factor analysis and correlation analysis was conducted. Between-group comparison was conducted using independent sample t-tests. RESULTS: K-AES showed good reliability and validity. Factor analysis confirmed 3 factors, which represented interest and drive, initiative, self-awareness and self-assessment. Patients with schizophrenia showed significantly higher K-AES and BDI scores than the healthy group. K-AES scores in patients with schizophrenia were significantly correlated with the PAS score, but did not correlate with SAS and BDI scores. CONCLUSION: This study demonstrates the reliability and validity of the K-AES. Our findings also suggest that the K-AES may be a reliable instrument in assessing apathy as a negative symptom in patients with schizophrenia.
Anhedonia ; Apathy* ; Depression ; Factor Analysis, Statistical ; Humans ; Reproducibility of Results* ; Schizophrenia* ; Self-Assessment ; Weights and Measures

BACKGROUND: Cyclosporine (CS) is widely used to treat various skin diseases. Gastrointestinal (GI) discomfort is the most common adverse effect of orally administered CS for dermatologic indications. However, few studies on CS-associated adverse GI events have been conducted. OBJECTIVE: In this study, we aimed to describe the major features of adverse GI events associated with CS therapy using a validated symptom questionnaire, and to investigate the factors contributing to their development. We also evaluated the effectiveness of three empirical GI medications in relieving adverse GI events. METHODS: This study consisted of 2 phases. Phase I was a prospective observational cohort study to investigate the characteristics of CS-associated adverse GI events in 942 consecutive patients treated with CS. Phase II was a randomized controlled trial to evaluate the efficacy of three different classes of GI medications. RESULTS: CS-associated adverse GI events occurred in 119 patients (12.6%). GI complications were more common in female patients (p=0.04), patients with a history of GI disorders (p=0.02), and patients whose initial CS doses were greater than 3 mg/kg/day (p=0.05). In patients treated with any one of the three GI medications, the mean Gastrointestinal Symptom Rating Scale scores significantly decreased (p<0.001). CONCLUSION This study demonstrated that adverse GI events are common during early CS treatment, especially in women, patients receiving high doses of CS, and those with a history of GI disorders. Our results suggest that new-onset CS-associated GI side effects can be effectively managed with the addition of GI medications.

This study examined foodservice management performance in child-care centers and suggests ways in which meal service quality can be improved. Questionnaires were distributed to 51 child-care facilities. The majority of respondents were facility directors (dietitians) and their facility type was tax-paid (92.2%). The dietitian response rate was 51.0%, and the majority (96.2%) were hired with co-management status, visiting a facility once a week (76.0%). Only 52.1% of the facilities had menu planning by a dietitian, and improvements were needed in terms of planning menus with standardized recipes, especially for infant meals. The monthly food cost per child was 47,394 won, and the labor cost for a co-management dietitian was 3,670 won per child, indicating 21.8% and 1.8% of the tuition fee, respectively. Other necessary improvements included: more reliable food purchasing management, securing additional foodservice equipment, and better sanitation management. In addition, respondents rated the following as requirements to ensure high quality meal service: 'modernized foodservice equipment and facilities', 'government financial support', and 'information on nutrition and foodservice management provided by dietitians'. Based on the study results, the following are recommendations for improving meal service quality in child-care centers: Dietitian placement should be extended to facilities of over 50-capacity in addition to their current placement in facilities of over 100-capacity, and co-management dietitians should have their control span restricted to two facilities instead of five. Finally, nationwide nutrition support plans and nutrition education programs should be developed and implemented by dietitians, and their roles should be extended to foodservice mangers as well as nutrition teachers.
Child ; Surveys and Questionnaires ; Dietary Sucrose ; Fees and Charges ; Humans ; Infant ; Meals ; Menu Planning ; Sanitation

Harlequin baby may represent the extreme form of lamellar ichthyosis or may be a distinct entity. It is inherited as an autosomal recessive trait, but it's cause is unknown, although the abnormalities of keratinization and epidermal lipid metabolism have been suggested. We recently experienced a case of harlequin baby in a male neonate who showed the typical skin appearance at birth. His skin was markedly thickened and cracked, and large horny plates were formed over the entire body. His face was disfigured, and the nose and ear were flattened by the thickened skin. The chemosis and severe ectropion obscured the orbits, and his lips were everted and gaping. The inelastic skin resulted in flexion of all joints, and hands and feet appeared fixed and ischemic. The pathologic findings of skin biopsy were compatible to the lamellar ichthyosis and his family history was nonspecific. We managed the patient with supportive care for his special skin lesion, along with the trial of retinoic acid. However, the treatment was withheld and the baby was discharged against medical advice as the parents wised, and the baby died 5 days after discharge.
Biopsy ; Ear ; Ectropion ; Foot ; Hand ; Humans ; Ichthyosis, Lamellar ; Infant, Newborn ; Joints ; Lip ; Lipid Metabolism ; Male ; Nose ; Orbit ; Parents ; Parturition ; Skin ; Tretinoin

BACKGROUND: We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia. METHODS: One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 µg and ketorolac 180 mg in Group K, and fentanyl 600 µg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded. RESULTS: Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups. CONCLUSIONS: Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.
Analgesia, Patient-Controlled* ; Analgesics* ; Cholecystectomy, Laparoscopic ; Fentanyl ; Humans ; Incidence ; Ketorolac* ; Nefopam* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Prospective Studies* ; Respiration

Sorafenib is an inhibitor of receptor tyrosine kinases and the rat sarcoma/mitogen-activated protein kinase (RAS/MAPK) pathway that is approved for the treatment of patients with metastatic hepatocellular carcinoma (HCC) and renal cell carcinoma. Sorafenib is known to have various cutaneous adverse effects, including hand-foot reaction, facial and scalp eruption, xerosis, and alopecia1.A 56-year-old man presented with non-painful, nonpruritic psoriasiform lesions that has been present for approximately 1 month (Fig. 1A∼E). Six months prior to presentation, he had been prescribed sorafenib at a daily dosage of 600∼800 mg after diagnosis of HCC with distant metastasis to the lung. A punch biopsy showed psoriasiform dermatitis (Fig. 1F, G). The skin lesions improved gradually after discontinuing sorafenib. However, at 1 month after discontinuation of sorafenib, considering the dose-dependent adverse effect of the medication, the patient resumed sorafenib at 400 mg daily after an oncology consultation. The lesions recurred beginning at 1 week after restarting sorafenib. A clinical diagnosis of sorafenib-associated psoriasiform drug eruption was made. The sorafenib treatment was maintained at 400 mg daily in conjunction with concurrent phototherapy and topical and intralesional corticosteroids for thick erythematous plaques, and intermittent systemic corticosteroid treatment when the cutaneous eruptions flared up.After approximately 2 years of sorafenib treatment, the patient presented with new crusting lesions without any other systemic adverse reactions. Multiple papules and plaques with central hyperkeratotic and crusted papules were present (Fig. 2A∼D). Punch biopsy showed a ‘perforating phenomenon’ (PP) (Fig. 2E∼G). The brownish hyperkeratotic crusts occurred consistently in prolonged psoriasiform plaques and resolved over time (Fig. 2A∼D). The psoriasiform eruptions and delayed-onset PP persisted with continuing sorafenib use (Fig. 2H). Along with a dose-decrease of sorafenib at 400mg daily, he was treated with systemic and topical corticosteroids, intralesional triamcinolone injection and narrowband ultraviolet B therapy. However, the patient showed recurrent cutaneous lesions aggravation upon tapering the dosage of corticosteroid.The psoriasiform lesions improved and then worsened with sorafenib dose change, and the PP featured hyperkeratotic crusts within multiple, long-lasting psoriasiform plaques. This phenomenon might have occurred to eliminate connective tissue or inflammatory material2 and differs from the appearance of transepidermal elimination in previously reported sorafenib-associated acquired perforating dermatosis cases3,4. Transepidermal elimination is a similar process to wound healing2, and considering that our patient had no history of diabetes, renal insufficiency, and trauma, our case might have exhibited the perforating and resolving phenomenon in response to the abnormal psoriasiform drug eruption.The RAS/MAPK cascade that is inhibited by sorafenib could be activated paradoxically; due to its role in antiangiogenesis, this activation results in epidermal disruption. The reduction and suppression of the hepatocyte growth factor-enhanced expression of matrix metalloproteinase induced by sorefenib could influence homeostasis of dermal elastic fibres, resulting in their disruption5. A few cases of psoriasiform drug eruption and PP after administration of sorafenib and other various tyrosine kinase inhibitors have been reported.The PP could represent a manifestation of the resolution of inflammation whereby the psoriasiform hyperplasia and the proliferated dermal tissue might be eliminated via a trans-epidermal route.

PURPOSE: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. METHODS: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. RESULTS: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. CONCLUSION: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.
Calcium Channel Blockers ; Calcium Channels* ; Calcium* ; Humans ; Hypoglycemia ; Hypokalemia ; Insulin ; Poisoning ; Prospective Studies ; Publication Bias ; Publications ; Research Personnel ; Retrospective Studies

Peribiliary cysts involve cystic dilatation and necroinflammatory change in the peribiliary glandular tissue of the larger biliary tree in association with portal hypertension or severe hepatobiliary disease. They are usually asymptomatic and found incidentally. However, rare cases causing symptoms or the mass effect of bile duct compression require differential diagnosis. They may be benign or malignant lesions resulting from narrowing of the bile duct and involving dilatation of the proximal intrahepatic bile duct. We recently encountered a case of peribiliary cysts associated with intrahepatic duct dilatation, and confirmed by surgery, and present the imaging and pathologic findings. Sonography and CT revealed the presence of multiple cystic lesions along the hepatic hilum, and the larger left portal tract and left intrahepatic ducts were dilated. Histopathologic examination indicated that the cysts were compressing the central bile duct.
Bile Ducts ; Bile Ducts, Intrahepatic* ; Biliary Tract ; Diagnosis, Differential ; Dilatation ; Hypertension, Portal