BACKGROUND AND SIGNIFICANCE: Cytomegalovirus(CMV) is the most common opportunistic viral agent encountered in AIDS and its relation to peripheral neuropathy and rapidly developing lumbosacral polyradiculopathy has been well documentated. CASE: A 30-year-old man with acquired immune deficiency syndrome presented with rapidly progressive paraplegia and voiding difficulty. Electrophysiologic studies revealed a lumbosacral polyradiculopathy with loss of bulbocavernous reflex and CSF examination showed polymorphonuclear pleocytosis with elevated protein level. Also, spinal T1-weighted MRI with gadolinium-DTPA showed enhancement of the pial lining of the conus medullaris, cauda equina, and lumbar nerve roots. Anti CMV titers were elevated in CSF and culture for CMV in both blood and urine was positive. The patient was treated with ganciclovir. CONCLUSION: We report a case of polyradiculopathy related to CMV in a patient with acquired immune deficiency syndrome(AIDS). It seems to be important to differentiate this unique syndrome from other causes of rapidly developing paraplegia syndromes among AIDS patients.
Acquired Immunodeficiency Syndrome* ; Adult ; Cauda Equina ; Conus Snail ; Cytomegalovirus* ; Ganciclovir ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Paraplegia ; Peripheral Nervous System Diseases ; Polyradiculopathy* ; Reflex

We report a non-obese patient suffering from spastic gait and right leg paresis caused by thoracic spinal cord compression secondary to spinal epidural lipomatosis. Although spinal epidural lipomatosis is most often associated with the administration of exogenous steroid or endogenous Cushing syndrome, obesity also has been reported as a possible cause. However, idiopathic(non-glucocorticoid induced) spinal epidural lipomatosis in non-obese healthy man is an extremely rare disease and dose not have any good explanation for the abnormal fat deposition in spinal epidural space. We recently experienced a patient with idiopathic thoracic epidural lipomatosis in whom MRI and histopathology established the specific diagnosis. With a case report, brief review of the disease including clinical feature, diagnostic procedure and therapeutic considerations is described.
Cushing Syndrome ; Diagnosis ; Epidural Space ; Gait Disorders, Neurologic ; Humans ; Leg ; Lipomatosis* ; Magnetic Resonance Imaging ; Obesity ; Paresis ; Rare Diseases ; Spinal Cord Compression

BACKGROUND AND OBJECTIVES: Diagnosis by Related Groups (DRG), a system forcibly implemented in all medical institutions from July 2013, was applied to tonsillectomy and adenoidectomy in the field of Otorhinolaryngology. We analyzed the changes in medical costs and evaluated the efficiency of the DRG system by analyzing the data collected before and after the DRG implementation. SUBJECTS AND METHOD: We analyzed the total number of cases, total medical costs and per charge for tonsillectomy and adenoidectomy using the data from the Korean National Health Insurance from 2011 to 2014. We compared the number and cost of tonsillectomy and adenoidectomy by hospital type, region, and patient age. RESULTS: The total number of tonsillectomy and adenoidectomy after the application of DRG systems in July 2013 in all medical institutions was reduced, but the total costs showed a tendancy to increase, resulting in an increase per charge of case. The number of tonsillectomy and adenoidectomy was decreased in general and specialized hospitals, but the costs were increased after DRG systems. CONCLUSION: Medical costs per charge of case related to tonsillectomy and adenoidectomy was higher in the DRG system than in the 'fee for service' system. Increased medical costs, considered to be the most likely cause of patient copayments, are recognized in the DRG system. The results showed that saving effect of medical costs was not significant in the DRG system; it may appear to relieve patient burden in the short term, but the financial state of national health insurance is worsening.
Adenoidectomy ; Diagnosis* ; Diagnosis-Related Groups ; Humans ; Insurance, Health* ; Methods ; National Health Programs ; Otolaryngology ; Tonsillectomy*

Bilateral sudden sensorineural hearing loss (SSNHL) is rare and usually indicates a serious systemic pathology. We describe an unusual case of bilateral SSNHL caused by sepsis. A 28-year-old female complained of acute-onset bilateral hearing impairment; in addition to otological symptoms, she had a systemic condition that met the criteria for sepsis. We performed a physical examination and laboratory tests to diagnose sepsis. Pure tone audiogram and videonystagmography were performed to evaluate the otological symptoms. Intravenous antibiotics and high-dose methylprednisolone were prescribed for treatment, and audiogram was repeated during that period. The fever subsided and the vital signs were stabilized. The electrolyte imbalance and abnormal urine parameters became normal. Hearing gradually recovered to a normal level on day 7 of hospitalization. In conclusion, sepsis should be considered as a cause of SSNHL. When conducting a detailed examination of patients with bilateral SSNHL, the clinician should consider systemic disease.

CYP1A2, CYP2D6 and N-acetyltransferase activities were estimated in 100 patients with bladder cancer and 84 control subjects from measurements of theophylline, metoprolol and isoniazid and their metabolites in urine, respectively. The frequency of occurrence of slow acetylators of isoniazid and poor metabolizers of metoprolol were 16.7% and 1.2% in the control group and 16.3% and 2.0% in the cancer patient group. These differences were not significant. The recovery ratio of 1-methyluric acid(1-MU) from theophylline was significantly higher in patients with bladder cancer than in control subjects(0.340 +/- 0.016 versus 0.260 +/- 0.020, p< 0.05). The 1-MU recovery ratio was a significant, independent risk factor among the metabolic capacities tested as shown by logistic regression analysis, controlling for N-acetylation of isoniazid, hydroxylation of metoprolol, age, sex, and smoking. We concluded that the capacity for 3-demethylation of theophylline, as a reflection of CYP1A2 activity, is significantly associated with increased risk of nonoccupational urinary bladder cancer.
Acetylation ; Adult ; Aged ; Amines/metabolism ; Bladder Neoplasms/enzymology/*epidemiology ; Carcinoma, Transitional Cell/enzymology/*epidemiology ; Case-Control Studies ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System/metabolism/*urine ; Disease Susceptibility ; Enzyme Induction ; Female ; Human ; Isoniazid/*pharmacokinetics ; Korea/epidemiology ; Logistic Models ; Male ; Methylation ; Metoprolol/*pharmacokinetics ; Middle Age ; Mixed Function Oxygenases/metabolism ; Mixed Function Oxygenases/metabolism ; Oxidoreductases/*urine ; Smoking ; Support, Non-U.S. Gov't ; Theophylline/*pharmacokinetics ; Uric Acid/analogs & derivatives/urine

Background and Objectives: To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group. Results: No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group. Conclusion MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

OBJECTIVES: It has been reported that caregivers of patients with chronic mental illness including schizophrenia are in higher risk for psychological and physical health problem. This study was performed to evaluate the depressive symptoms and associated factors in caregivers of patients with chronic mental illness. METHODS: The subjects were 77 unaffected caregivers (30 parents, 30 siblings, 10 offspring, and 7 spouses) of patients with chronic mental illness (62 schizophrenia, 4 schizoaffective disorder, 11 bipolar disorder) and 100 healthy controls. Depressed mood was assessed by Beck Depression Inventory (BDI) in all subjects. For their sick family members, clinical factors including psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS), duration of illness, number of admission were assessed. RESULTS: The mean BDI score of the caregivers was significantly higher than that of control subjects (11.2+/-11.6 and 8.0+/-7.5). Given that 23.4% of family group and 23.0% of control group are attributed to mild to moderate depressed state and 22.0% of family group and 8.0% of control group to above moderate depressed state, significant depressive symptom is more frequently observed in family group. The mean BDI score of parent group was higher than that of sibling group controlling for sex and age. In the parent group, BDI scores are positively correlated with age while the offspring and spouse group had negative correlation between BDI scores and age. Higher age, lower socioeconomic state, more severe positive symptom scores of patients were potential predictors for BDI scores of caregivers. CONCLUSION: This study showed that caregivers of patients with chronic mental illness have significant depressive symptoms. It may be suggested that depressive symptoms of caregivers are associated with aging, low socioeconomic state, and severe positive symptom rather than chronicity of their sick family members.
Aging ; Caregivers ; Depression ; Humans ; Parents ; Psychotic Disorders ; Schizophrenia ; Siblings ; Spouses

The accessory middle cerebral artery (MCA) is a variation of the MCA branching, which originates from the anterior cerebral artery (ACA). It is deemed as an incidental anatomical finding and the incidence is reported to be 0.3% to 4.0%. Although the accessory MCA is infrequent it nevertheless may have important implications in the interpretation of transcranial Doppler (TCD) findings. We report two patients having an accessory MCA and its clinical significance.
Anterior Cerebral Artery ; Humans ; Incidence ; Middle Cerebral Artery*

BACKGROUND: Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. OBJECTIVE: We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. METHODS: The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. RESULTS: The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. CONCLUSION: The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW.
Cost of Illness ; Costs and Cost Analysis ; Delivery of Health Care ; Dermatitis, Atopic* ; Health Expenditures ; Humans ; Insurance, Health ; Korea ; Prevalence ; Public Health ; Quality of Life ; Surveys and Questionnaires

BACKGROUND: The loss or depression of ankle jerk has been considered one of the earliest physical findings of diabetic polyneuropathy, even in asymptomatic cases. Therefore, the electronic ankle T-reflex test (ATR) could be a sensitive, objective test for the early detection of polyneuropathy among diabetics. METHOD: In order to verify the sensitivity and usefulness of the ATR, the ankle jerk and ATR were studied in 99 legs of 50 patients with diabetes who did not have any symptoms related to neuropathy or peripheral vascular disease at the time of the study. A sensory nerve conduction study (SNCS) of sural and superficial peroneal nerves was also performed and the results were compared with the ATR. RESULTS: The ATR response was abnormal in 42.4% of the legs tested and was more sensitive than the sural SNCS (18.2%) or superficial peroneal SNCS (30.3%) in revealing subclinical abnormalities. Our results confirm that ATR abnormalities in asymptomatic diabetics are more frequent than conventional SNCS abnormalities and are a reliable indicator of peripheral nerve dysfunction in diabetic patients. CONCLUSIONS: The ATR seems to be a sensitive test in detecting subclinical abnormalities in diabetics and would be useful especially in early or equivocal cases of
Ankle ; Depression ; Diabetes Mellitus ; Diabetic Neuropathies ; Electrophysiology ; Humans ; Leg ; Neural Conduction ; Peripheral Nerves ; Peripheral Vascular Diseases ; Peroneal Nerve ; Polyneuropathies