OBJECTIVES: Considerable variations in the contents of clinical practice are the natural consequences of the fact that so many factors can have influences on each clinical decision making processes in the psychiatric treatment, let alone the pharmacotherapy of schizophrenia. To attain the goal of rational treatment, it is needed to examine the actual contents of clinical practices and the degree of variations among diverse hospitals. In addition, it is also needed to look into the unique situations in which each hospital is situated. For this purpose, this study tried to investigate the degree of variations in several aspects of the treatment of schizophrenia with atypical antipsychotics currently practiced in Korea. METHODS: This study is based on the data from RODOS (Risperidone Olanzapine Drug Outcome Study) in Korea. This study had been designed as a multi-center naturalistic study, therefore, had many advantages for the survey study of actual clinical practices. The subjects of the study were the in-patients who had been given risperidone or olanzapine for the control of their psychotic symptoms. Clinical data had been gathered by retrospective chart review. The degree and the characteristics of the variations were examined by comparing the patient-characteristic variables and the treatment-related variables among each hospital. RESULTS: The differences in the baseline characteristics of the patients including the duration of illness and the past history of psychiatric treatment were substantial among each hospital, and these differences seemed to explain a great portion of the variations in the contents of treatment. The variations in the dosage of risperidone and olanzapine were not conspicuous among each hospital. However, the variations in other treatment-related variables, including duration of admission, proportion of combined therapy with other antipsychotics, usage of anticholinergics, detection rate of extrapyramidal symptoms, remained statistically significant after adjusting the baseline patient characteristics as covariates. Although no significant correlation among each variable was found, a couple of unique practice patterns common to several hospitals could be observed. CONCLUSIONS: Considerable variations in the diverse treatment-related variables were observed in the treatment of schizophrenic patients with risperidone and olanzapine. It seemed that the major portion of these variations could be explained by the characteristic of patient group. However, the possibility remained that the other factors including the socio-cultural environment of the community and the disposition of the clinician themselves were still the major contributing factors to these variations. It is expected that the future clinical practice surveys like this study can help the clinicians to reevaluate their current practices, and can help to accumulate the basic data needed to establish the more rational and customized treatment practices.
Antipsychotic Agents ; Cholinergic Antagonists ; Decision Making ; Drug Therapy ; Humans ; Korea ; Linear Energy Transfer ; Retrospective Studies ; Risperidone* ; Schizophrenia

PURPOSE: The purpose of this study was to examine the effect of a group coaching program (GCP) on depression, anxiety, and hope in women breast cancer patients undergoing chemotherapy. METHODS: A total of 152 patients were enrolled and randomly assigned to an experimental group receiving the GCP (N=76) and an untreated control group (N=76). Data collection consisted of three measurements of depression, anxiety, and hope (pre, post, and 3weeks later). The intervention was a one-time GCP consisting of 5 subparts for 30~40 minutes for a group of 3~4 people, conducted by a single nurse. RESULTS: The scores of depression, anxiety, and hope changed significantly over time (p<.001, p<.001, p<.001). Depression, anxiety, and hope changes were significantly different between the experimental and control groups (p<.001, p<.001, p<.001). There was a difference in depression, anxiety, and hope among the groups according to the implementation of the GCP (p<.001, p<.001, p<.001). In the experimental group, depression, anxiety, and hope level were significantly different between the pre- and post-test (p<.001), pre- and 3weeks later-test (p<.001), but not in the control group. CONCLUSION: The GCP for women breast cancer patients receiving chemotherapy was effective in reducing depression and anxiety, and increasing hope.
Anxiety* ; Breast Neoplasms* ; Breast* ; Data Collection ; Depression* ; Drug Therapy* ; Female ; Hope* ; Humans

Cutis laxa is a rare disorder of the elastic tissue characterized by loosely hanging and folded skin giving a premature senile appearance, often with internal organ involvement. Recently, we experienced a case of cutis laxa in a neonate. The patient who presented with dyspnea and loose skin at birth was delivered by Cesarean section in our hospital. He was the third baby of his mother and his siblings had no problem including skin. Physical examination on admission revealed a dyspneic neonate with skin showing loose folds, wrinkles and sagging over the face, neck, trunk and thighs. He had no family history of skin disease suggestive of cutis laxa. Histopathologic study of the skin specimen showed widespread breakdown and decreased number of elastic fibers with granular degeneration, shortening, and fragmentation. He had been dependent on ventilatory support throughout his hospital course and finally succumbed to intractable pulmonary emphysema at the age of 220 days.
Cesarean Section ; Cutis Laxa* ; Dyspnea ; Elastic Tissue ; Female ; Humans ; Infant, Newborn ; Mothers ; Neck ; Parturition ; Physical Examination ; Pregnancy ; Pulmonary Emphysema* ; Siblings ; Skin ; Skin Diseases ; Thigh

BACKGROUND: It is well known that there is wide individual variation of responsiveness when parasympathetic nervous system is stimulated physiologically, pathologically, and therapeutically. But no appropriate explanation is present for that yet. So the purpose of this study is to verify individual diversity of vagal tone during resting state and after vagal stimulation and to find factor that may significantly contribute to it. METHOD: We serially measured variation of heart period(VHP : sec) which had been known to be an accurate index of cardiac parasympathetic tone during resting state(VHPb) and after vagal stimulation by ice water application to face(VHPv). And we analyzed correlation between VHPb, VHPv and ratio of VHPv to VHPb(ratio). RESULT: There was wide variation of vagal tone both in resting state (VHPb : 0.025-0.161) and after vagal stimulation (VHPv : 0.087-0.661). VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb<0.07, B : 0.07-0.1, C : >0.1). The low VHPb group A showed dramatic increase in vagal tone after vagal stimulation (ratio 2.21-20.24 mean 7.7), on the other hand high VHPb group C did not (ratio 0.80-2.55 mean 1.39). There ws also a significant negative correlation between VHPb and ratio (r=0.69, p<0.001). CONCLUSION: These results suggest that there is wide individual diversity of responsiveness to vagal stimulation and magnitude of vagal tone in resting state is an important factor to determine the responsiveness to vagal stimulation.
Child* ; Hand ; Heart ; Humans ; Ice ; Parasympathetic Nervous System ; Water

BACKGROUND: Lowering the wound infection rate is very important to decrease morbidity, mortality, and the cost of therapy. We wanted to know the bacteriologic pathogen of surgical infection, to verify the role and proper selection of prophylactic antibiotics, and to figure out the risk factors of surgical infection in the biliary area. METHODS: A prospective study was done for 109 patients who underwent biliary operations, excluding laparoscopic cholecystectomy from Mar. 1997 to Feb. 1998. Bacteriologic data were collected from 96 patients among them. Wound infection was defined as a purulent discharge from the wound. Ordinary bacterial cultures were taken from the peritoneal cavity (liver bed) and the wound subcutaneous area. Items of investigations were age, sex, degree of obesity, operation time, ASA classification, incision, suture materials, transfusion, used antibiotics, serum albumin, serum glucose, and hemoglobin. Statistical analysis were done with the Mann-Whitney-Wilcoxon-rank test, the Students t-test, the Chi-square test, and Fishers exact test. RESULTS: Wound infections occurred in 5 cases (4.8%). Culture positivity from the wounds was 38.5% (37/96), and that than the peritoneal cavity were 40.6% (39/96). The bacteria isolated from the peritoneal cavity were mainly gram-negative rods (E. coli, Klebsiella, Enterobacter, Pseudomonas, Serratiae, Morganella); gram-positive cocci were also isolated (Enterococcus, Streptococcus). The most common bacteria isolated from the wound was gram-positive Enterococcus; gram-negative rods were also common (Klebsiella, E. coli, Enterobacter). Of the investigated risk factors, a positive culture and biliary tract infection were statistically significant risk factors of wound infection (p<0.05). CONCLUSION: Taking a bacterial culture from the wound and from the peritoneal cavity is important because it directly correlates with the degree of contamination and defines a high risk of infection. Prophylactic antibiotic administration with 3rd generation cephalosporin and aminoglycoside is justified in view of the organisms isolated from the culture.
Anti-Bacterial Agents ; Bacteria ; Biliary Tract ; Blood Glucose ; Cholecystectomy, Laparoscopic ; Classification ; Enterobacter ; Enterococcus ; Gram-Positive Cocci ; Humans ; Klebsiella ; Mortality ; Obesity ; Peritoneal Cavity ; Prospective Studies* ; Pseudomonas ; Risk Factors* ; Serratia ; Serum Albumin ; Sutures ; Wound Infection* ; Wounds and Injuries*

PURPOSE: The purpose of this study was to assess the hard and soft tissue changes associated with mandibular bilateral sagittal split osteotomy and genioplasty. METHODS: This is a retrospective study of 40 patients who underwent either bilateral sagittal split osteotomy for mandibular setback (BSSO group, n = 20) or in combination with advancement genioplasty (Genio group, n = 20). Lateral radiographs, were taken before and immediately after surgery, and at least 6 months after surgery. RESULTS: Comparing hard and soft tissue changes between the BSSO group and Genio group, there were significant differences in the lower incisor, soft tissue B point (B'), and soft tissue Pogonion (Pg') (p < 0.5). The mean ratio of hard and soft tissue changes for B/B', Pg/Pg', and Menton/soft tissue Menton after surgery in the BSSO group was 0.997, 0.965, and 1.022 respectively, and 0.824, 0.602, and 0.887 respectively in the genio group. Significant differences were found between the two groups. There were significant differences in lip thickness (B-B', Pg-Pg') in the Genioplasty group between pre and postsurgery, but not in the BSSO group. Pogonion to Labrale inferior and B' had a correlation coefficient of 0.833, 0.922, respectively for the BSSO group, and 0.775, 0.799 for the Genio group. CONCLUSIONS: The results indicate that there is a significant difference between bilateral sagittal split osteotomy with or without genioplasty in the lower facial esthetics values. The combination of mandibular setback and genioplasty had a smaller change in soft tissue thickness of the symphysis area after surgery than that of mandibular setback only.
Esthetics ; Genioplasty ; Humans ; Incisor ; Lip ; Osteotomy ; Retrospective Studies ; Sitosterols

Galactosemia is a group of inherited enzyme deficiencies characterized by increase in the blood galactose levels. This condition may be associated with deficiencies of galactose-1-phosphate uridyl transferase, galactokinase, or uridine diphosphate galactose-4-epimerase. However, the elevated galactose identified by neonatal screening tests has several other possible etiologies, including hepatic hemangioendothelioma, hepatic hemangioma, and patent ductus venosus with hypoplasia of the portal vein. We report a 13-day-old Korean male with hepatic hemangioendothelioma, which was incidentally detected during the evaluation for suspected galactosemia. Laboratory studies revealed that mildly elevated levels of galactose, galactose-1-phosphate and alpha-fetoprotein, at the time of admission, were gradually decreased to the normal range over the 6 months of observation. Ultrasonography showed a well-defined heterogeneous hypoechoic mass in the liver, and magnetic resonance imaging study showed multiple enhanced mass lesions, which was compatible with the diagnosis of a hepatic hemangioendothelioma. Thus, hepatic imaging, especially ultrasonography, should be performed if neonatal screening suggests galactosemia.
alpha-Fetoproteins ; Galactokinase ; Galactose ; Galactosemias ; Galactosephosphates ; Hemangioendothelioma ; Hemangioma ; Humans ; Infant ; Infant, Newborn ; Liver ; Magnetic Resonance Imaging ; Male ; Neonatal Screening ; Portal Vein ; Reference Values ; UDPglucose-Hexose-1-Phosphate Uridylyltransferase ; Uridine Diphosphate ; Vascular Malformations

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.Case presentationHere, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.Case presentationHere, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

OBJECTIVES: The aim of this study was to investigate the effects of some commercial calamansicontaining beverages on the sound surface of bovine teeth as well as the dental erosion inhibitory effects of calcium. METHODS: The pH and titratable acidity of six kinds of commercially available calamansi beverages were determined. Further, 3% calcium was added to the calamansi beverage Oranssi in the experimental group to confirm its dental erosion inhibitory effect. Jeju Samdasoo was used in the negative control group and Coca-Cola in the positive control group. After immersing the sound teeth specimens for 10 min, surface microhardness was measured using the Vickers hardness number (VHN), and surface changes in specimens were observed under a scanning electron microscope. RESULTS: The average pH of the commercial calamansi beverages was 2.54±0.22. After 10 min of treatment with each experimental beverage, the surface hardness difference (ΔVHN) was highest in the Coca-Cola group (−49.05±12.59), followed by the Oranssi calamansi group (−43.77±13.70), 3% calcium-added Oranssi calamansi group (−2.71±12.58), and Samdasoo group (14.03±20.79). There was no significant difference between the bottled water and calcium-added Oranssi calamansi groups or between the Coca-Cola and Oranssi calamansi groups (P>0.05). However, there was a significant difference in the surface hardness between the bottled water and CocaCola groups (P<0.05). On scanning electron microscopy, the Samdasoo group showed a smooth surface without any loss, but Coca-Cola and Oranssi calamansi groups showed a rough surface due to erosion. However, although fine cracks and porosities were seen in the calcium-added Oranssi calamansi group, surfaces in the group were much smoother than those in the Oranssi calamansi group. CONCLUSIONS Calamansi beverages of low pH may cause corrosion of the tooth surface, and the addition of calcium to the calamansi beverages inhibits demineralization of the tooth surface. Therefore, it is necessary to consider the risk of dental erosion when drinking calamansi beverages of low pH.