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

OBJECTIVES: Auditory verbal hallucination (AVH) is knoun for its high prevalence and difficulty in evaluation. Authors hypothesized that it may be possible to find useful dimensions of AVH that reflect the clinical status of schizophrenic patients by assessing the multi-dimensional changes and linguistic forms' of AVH during antipsychotic treatment. METHODS: 33 schizophrenic patients with AVH were selected and periodically assessed with the 11 items of hallucinations subscale of 'The Psychotic Symptom Rating Scales (PSYRATS)'. In addition, to assess the linguistic forms observed in the AVH, the evaluations of sentence structure of AVH reported by the patients were conducted. RESULTS: PSYRATS showed the multidimensionality inherent in AVH. The changes in the quantitative dimensions did not correlate well with patients' subjective distress. However, qualitative changes in the cognitive and emotional dimensions showed more favorable correlation with clinical course of the patient. The sentence structures of AVH showed tendency to change from "sentence" to "non-sentence" type with overall improvement during treatment. CONCLUSION: Multi-dimensional approach to AVH can give us more information about the changing patterns of multi-faceted structure of AVH and clinical status of patients than one-dimensional or categorical approach.
Hallucinations* ; Humans ; Linguistics ; Prevalence ; Weights and Measures

OBJECTIVES: Auditory verbal hallucination (AVH) is knoun for its high prevalence and difficulty in evaluation. Authors hypothesized that it may be possible to find useful dimensions of AVH that reflect the clinical status of schizophrenic patients by assessing the multi-dimensional changes and linguistic forms' of AVH during antipsychotic treatment. METHODS: 33 schizophrenic patients with AVH were selected and periodically assessed with the 11 items of hallucinations subscale of 'The Psychotic Symptom Rating Scales (PSYRATS)'. In addition, to assess the linguistic forms observed in the AVH, the evaluations of sentence structure of AVH reported by the patients were conducted. RESULTS: PSYRATS showed the multidimensionality inherent in AVH. The changes in the quantitative dimensions did not correlate well with patients' subjective distress. However, qualitative changes in the cognitive and emotional dimensions showed more favorable correlation with clinical course of the patient. The sentence structures of AVH showed tendency to change from "sentence" to "non-sentence" type with overall improvement during treatment. CONCLUSION: Multi-dimensional approach to AVH can give us more information about the changing patterns of multi-faceted structure of AVH and clinical status of patients than one-dimensional or categorical approach.
Hallucinations* ; Humans ; Linguistics ; Prevalence ; Weights and Measures

Respiratory distress syndrome (RDS) of preterm infants remains a significant cause of morbidity and mortality despite improvements in neonatal intensive care and artificial ventilatory techniques. After identification of the deficiency of pulmonary surfactant is major pathophysiologic basis in RDS, artificial surfactant replacement therapy in RDS was first successfully tested by Fujiwara and co-workers in 1980. therefore, exogenous surfactant replacement produced exellent results in improved clinical and repiratory status during the acute period and decreased incidence of late complications and mortality. According to comparison of administration timing between early (within 6 hours after birth) and late (after 6 hours)group, early replacement therapy is more effective in improving of clinical course and prognosis. Because of that, early, just after birth, recognition and detection of RDS is also important procedure. There are many investigations and methods for the detection of RDS in prenatal or postnatal period. Among then, stable microbubble rating (SMR) test was a simple method and SMR test has a higher diagnostic accuracy. To determine the relation of the SMR and purified natural surfactant (PNS) concentration in vitro, the author conducted each 5 times test of SMR method according to 5 groups of PNS concentration by using modified Pattle's method. The results were as follows: 1) The mean and standard deviation of SMR according to 5 groups of PNS concentration were 119.4 (15.0in 20mug PL (phospholipid)/ml, 452.2 (160.2 in 40mug PL/ml, 879.0 (93.4 in 60mug PL/ml, 1311.8 (274.8in80mug PL/ml, 1710.6(272.3 in 100mug PL/ml. 2) The regression curve of SMR and PNS concentration showed statistically significant relation(p<0.005). In conclusion, the SMR test was a good method in estimation of surfactant concentration in vitro and also in diagnosis of RDS recognized as a surfactant deficiency. In the future, we expected that prophylactic surfactant replacement therapy. immediate after birth, will be more popular in the field of neonatal care of RDS. So, we recommended the use of this method for early detection and serving optimal care of RDS.
Diagnosis ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Microbubbles* ; Mortality ; Parturition ; Prognosis ; Pulmonary Surfactants*

No abstract available.
Hypersensitivity* ; Immunoglobulins* ; Otitis Media with Effusion* ; Otitis Media* ; Otitis*

Necrotizing colitis associated with carcinoma of the colon, Known also as obstructive colitis, is a disordercharacterized by anulceration and inflammation of the colon proximal to an obstructive lesion, especiallycarcinoma of the rectosigmoid colon, and in rare instances, leads to actual gangrene of the colon. The authorsanalysed radiologic findings in four cases of necrotizing colitis associated with carcinoma of the colon. Bariumenema disclosed mucosal edema, nodular filling defects, irregularity of the colonic controur and typicalthumbprinting appearance of involved colon proximal to an obstructing carcinoma of the colon. The mechanism ofnecrotizing colitis was briefly reviewed.
Colitis ; Colon ; Edema ; Gangrene ; Inflammation

Condyloma acuminatum, a benign disease caused by a filtrable virus, occurs predominantly in the perianal andgenital areas. The lesions are noninvasive but are subject to recurrence. In rare instances, a more aggresive formof this disease, known as "giant condlyloma acuminatum" or "Buschke-Lownestein tumor", occures. In this form,infiltration of the lesion into surrounding structures takes place. This tumor has been reported to occurprincipally in the genitourinary tract. The authors experienced a cases of giant condyloma acuminatum originatingfrom rectum in 67 years old male patient which recurred 3 months after electrofulguration.
Buschke-Lowenstein Tumor ; Humans ; Male ; Rectum ; Recurrence

In the unusual manifestation of right upper lobe collapse confusing with mediastinal or parenchymal mass, both alteration of the pulmonary vessels and shifting pattern of the collapsed lobe to the periphery on supine positionare the key to the diagnosis of it rather than mediastinal or parenchymal mass. The mechanisms of these unusual manifestation s are obscure, however lobar torsion and gravity factor are considered to be a main process. Authors have experienced 2 cases of unusual manifestations of right upper lobe collapse due to bronchogenic carcinomaduring resent 2 years in Kyung Hee University hospital, and prsent radiologic findings.
Carcinoma, Bronchogenic ; Diagnosis ; Gravitation

Management of subtrochanteric fractures of the femur is difficult because of the high mechanical stresses in this region; furthermore, the bone here is mainly cortical and comminution is frequent. These two factors, involvement of cortical bone tissue and concentration of stress, have been mentioned as reasons for the high incidence of complication in the treatment of these fractures, such as Relayed union, mechanical failure and rnalunion. Thirty cases of subtrochanteric fractures in twenty-nine patients were reviewed, which have been managed at the Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine from Jan. 1980 to Dec. 1984 and the following results were obtained: l. Of the 29 patients reviewed, 22 were male and 7 were female. Mean age was 45.7 years in male and 67.3 years in female. 2. Traffic accidents were the most common cause of injury(44.8%) 3. Pelvic bone fractures(7 cases) and rib fractures(7 cases) were the most common associated injuries. 4. Fielding's type II (13 cases) fracture and Seinsheimer's type IV (10 cases) fracture were most common. 5. Of the 30 cases, 26(86.7%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 13 cases (50.0%). 6. The mean duration of bony union was 20.4 weeks. There was no significant difference in union rate between fractures which were treated by operative means and fractures by conservative means. And more longer period was needed in union as fracture goes distally. 7. Weight bearing was allowed earlier in patients treated by operative means (average 10.5 weeks) than in patients by conservative means (average 18.0 weeks.). 8. Of the 30 cases, 8 complications (26.7%) occured, that is: delayed union(4 cases), mechanical failure (3 cases) and angular deformity(1 case). All of them occured in Fielding's type II and III fractures except 1 case. Loss of medial buttress and unstable reduction were considered to be causing factors. 9. Satisfactory result was obtained by stable anatomical reduction and internally fixed by Jewett nail and compression hip screw. In case of intramedullary nail, good result was expected when used in non-comminuted fracture of distal portion. Also, additional supplementary screw fixation, circlage wire and bone graft were recommended, when necessary.
Accidents, Traffic ; Bone and Bones ; Clinical Study ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Male ; Orthopedics ; Pelvic Bones ; Ribs ; Stress, Mechanical ; Transplants ; Weight-Bearing

With the development of antibiotics, tympanogenic labyrinthitis complicated by otitis media rarely occurs nowadays. Only few cases of acute serous or suppurative labyrinthitis in otitis media patients have been reported previously in the literature. Acute suppurative labyrinthitis caused by direct bacterial invasion into the inner ear leads to potentially severe, irreversible hearing loss, vertigo and spontaneous nystagmus toward the healthy side. Magnetic resonance image might be helpful to recognize the inflammatory lesions of the labyrinth. Treatment for tympanogenic labyrinthitis includes an appropriate use of antibiotics and establishment a draining route. Recently, we experienced an unusual case of acute suppurative labyrinthitis complicated by chronic otitis media without cholesteatoma. We also review and discuss the clinical manifestations, radiologic findings and treatment strategy of this disease.
Anti-Bacterial Agents ; Cholesteatoma ; Ear, Inner ; Hearing Loss ; Humans ; Labyrinthitis ; Magnetic Resonance Spectroscopy ; Otitis ; Otitis Media ; Vertigo