OBJECTIVE: The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers. METHODS: The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on. RESULTS: About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The questionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (+/-SD) of patients and caregivers were 41.9 (+/-10.2) and 62.2 (+/-13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively. CONCLUSION: There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved.
Antipsychotic Agents ; Caregivers ; Community Mental Health Centers ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Mental Health ; Prescriptions ; Surveys and Questionnaires ; Schizophrenia

Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures.
Abdominal Wall ; Cytochrome P-450 CYP1A1 ; Endoscopy ; Epithelium ; Gastrostomy ; Humans ; Nutritional Support ; Stomach

PURPOSE: Some patients who undergo surgical resection of pancreatic cancer survive longer than other patients. The purpose of this study was to identify the factors that affect long-term survival after resection of histopathologically confirmed pancreatic ductal adenocarcinoma. METHODS: A single-center, retrospective study was conducted among 164 patients who underwent surgical resection of pancreatic cancer, between May 1995 and December 2004. The patient follow-up process was conducted via telephone survey and review of electronic medical records for at least 5 years or until death. RESULTS: We compared patients with long-term (> or =60 months, n = 19) and short-term survival (<60 months, n = 145). Resection margin status, differentiation of the tumor, tumor stage, pre-operative serum level of albumin, total bilirubin and carbohydrate antigen (CA) 19-9 level are related with survival difference (all factors, P < 0.05). Multivariate analysis revealed that a pre-operative serum total bilirubin level <7 mg/dL and a pre-operative serum CA19-9 level <37 U/mL is a statistically significant prognostic factor for long-term survival. CONCLUSION: The preoperative serum total bilirubin and serum CA19-9 levels are associated with long-term survival after surgical resection of pancreatic cancer.
Adenocarcinoma ; Bilirubin ; Electronic Health Records ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Pancreatic Ducts ; Pancreatic Neoplasms ; Retrospective Studies ; Telephone

OBJECTIVES : Impaired autonomic function in patients with chronic renal failure has been well documented in a number of studies to assess the degree of cardiovascular autonomic dysfunction and to assess the relationship with plasma catecholamines. The purpose of the present study was to evaluate the prevalence of autonomic dysfunction and to determine the effect of autonomic dysfunction on the increment of plasma catecholamine, dialysis-induced hypotension and hypotension during chronic dialysis. METHODS: We measured the degree of autonomic damage and the concentration of plasma catecholamines in 20 patients on maintenance hemodialysis, 12 pre- dialysis patients with chronic renal failure and 20 normal controls using a standardized battery of five cardiovascular reflex tests. RESULTS: 1) In normal controls, 70% of cases had a normal or early parasympathetic abnormalities however in patients with chronic renal failure, 45.2% of patients had severe abnormalities. The prevalence of autonomic dysfunction was 62.5% and there was significant correlation between sympathetic and parasympathetic score in patients with chronic renal failure. 2) Although overall autonomic function was not different in two chronic renal failure groups, the magnitude of heart rate response to Valsalva maneuver was increased and the magnitude of fall of blood pressure in response to standing-up was reduced in dialyzed patients compared with nondialyzed patients. 3) Patients with autonomic dysfunction was older and had higher postdialysis concentration of plasma norepinephrine than those with normal autonomic function. 4) In dialyzed patients, predialysis concentration of plasma norepinephrine at rest varied widely and was significantly related to the duration of dialysis. Postdialysis concentration of norepinephrine was significantly correlated with the degree of parasympathetic damage. 5) There were no significant differences in autonomic damage or plasma catecholamines whether dialysis- induced hypotension and hypotension in chronic hemodialysis or not. CONCLUSION : Disturbances of autonomic nerve system are common in chronic renal failure with distinct abnormalities of parasympathetic function and additional sympathetic dysfunction. Elevated plasma norepinephrine seems to be related to the compensatory response of sympathetic nerve system to parasympathetic damage. Impairment of autonomic function does not appear specifically related to dialysis-induced hypotension or hypotension in chronic dialysis.
Autonomic Pathways ; Blood Pressure ; Catecholamines ; Dialysis ; Heart Rate ; Humans ; Hypotension ; Kidney Failure, Chronic* ; Norepinephrine ; Plasma ; Prevalence ; Reflex ; Renal Dialysis ; Valsalva Maneuver

During the last 7 years from Jan. 1973 to Dec. 1979, 106 cases of typhoid fever has been admitted to the department of Pediatrics of Won Ju Christian Hospital and evaluated clinicaIly. The results were summarized as follows 1. Tota1 number of the patients was 106, of which 62 were male and 44 were female. The peak age group was over 11 years of age and the youngest case was 6 month old male patient. The seasonal incidence was high in July to September. 2. The clinical symptoms on admission were as follows: fever(93.4%), abdominal pain(56.6%), headache(26.4%), nausea and vomiting(25.5%), diarrhea(20.3%) and cough(16.0%) The physical findings were as follows: fever(68.9~), injected throat(56. 690), hepatomegaly(50.0%), coated tongue(45.3%), abdominal tenderness(33.0%), splenomegaly(20.8%) and bradyeardie(16.0%). 3. Anemia was 41.590 and leukopenia was 27.4%. Widal test was positive in 73.6% of all 129 tests. The positive bacteriologic cultures were 56.9% in blood and 10.4% in stool, respectively. 4. The average days of defevervescence was 3. 66 days in CM, 3. 88 days in ampicillin, 2.80days in CM combined with ampicillin and 2.71 days in ampicillin with prednisolone, of each. The doplication was noted in 24 cases(22.6%), which included pneumonia(7 cases), intestinal perforation(7 cases) and intestinal hemorrhage(3 cases).
Ampicillin ; Anemia ; Female ; Gangwon-do ; Humans ; Incidence ; Infant ; Leukopenia ; Male ; Nausea ; Pediatrics ; Prednisolone ; Seasons ; Typhoid Fever*

The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Stroke

Biliary cystadenoma is a rare biliary ductal neoplasm that usually arises in the liver and less frequently in the extrahepatic bile ducts. Clinical manifestations are non-specific; hence preoperative diagnosis depends heavily on imaging. Computed tomography, ultrasonography, angiography and cholangiogram are useful diagnostic procedures in biliary cystic tumor, but definite diagnosis depends on histologic diagnosis. Surgical resection often yields excellent results. Surgical procedures used to treat cystadenomas include: aspiration, drainage, marsupialization, and excision. If there is no evidence of metastasis, complete resection of these tumors is necessary for a complete cure. We experienced an 80-year-old man who complained of jaundice and RUQ pain. He was diagnosed as biliary mucinous cystadenoma, We confirmed our diagnosis by cholangioscopic biopsy, and performed endoscopic sphincterotomy(EST). So, we report this case and have reviewed the relevant literature as a part of our report for the subject case.
Aged, 80 and over ; Angiography ; Bile Ducts, Extrahepatic ; Biliary Tract* ; Biopsy ; Cystadenoma ; Cystadenoma, Mucinous* ; Diagnosis ; Drainage ; Humans ; Jaundice* ; Liver ; Mucins* ; Neoplasm Metastasis ; Pancreas* ; Ultrasonography

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*

PURPOSE: To evaluate the tibia osteotome angle and whole leg alignment in total knee replacement arthroplasty using intramedullary tibia guide. MATERIALS AND METHODS: Amongst 343 cases of TKA using an intramedullary tibial cutting guide from November 1998 to August 2001, 160 cases who took a standing whole leg AP simple roentgenography within 1 year were selected. Post-operatively, the angle formed by the tibial anatomical axis and tibial component, along with the angle formed between the femoral anatomical axis and tibial anatomical axis were measured. RESULTS: The average angle between the tibial anatomical axis and tibial component was 89.5 degrees (84 degrees~94 degrees), 133 cases(83.1%) were within the range of 90 degrees +/- 2 degrees and amongst these 66 cases(41.3%) were 90 degrees. The average angle formed between the femoral anatomical axis and tibial anatomical axis was 5.6 degrees(0 degrees~11 degrees). CONCLUSION: When used properly, an intramedullary tibial cutting guide in TKA result in satisfactory tibial osteotome angle and whole leg alignment in TKA.
Arthroplasty* ; Arthroplasty, Replacement, Knee ; Axis, Cervical Vertebra ; Knee* ; Leg ; Radiography ; Tibia