PURPOSE: Paradoxical embolism due to the presence of patent foramen ovale(PFO) is a well-established possible mechanism of ischemic stroke of unknown origin, and the closure of PFO seems to be a kind of most effective method of the prevention of stroke recurrence. We report the initial and intermediate-term result of transcatheter closure of PFO associated with paradoxical embolism leading to cryptogenic transient ischemic attack or cerebrovascular accident using the Amplatzer(R) PFO Occluder. METHODS: From January 2003 through May 2005, 10 patients with PFO(4 male, 6 female) with history of at least 1 cryptogenic transient ischemic attack or cerebrovascular accident underwent percutaneous transcatheter closure of PFO using Amplatzer(R) occluder assisted by transesophageal echocardiography(TEE). All procedure were performed under general anesthesia and assisted by TEE. RESULTS: In all patients, the implantation procedure was successful and no significant complication was observed(in one case, peri-interventional ST-segment elevation observed). During the follow-up period of mean 13.1 months(range, 1-28 months), no recurrence of neurologic episode were observed and there was no residual shunt through PFO. CONCLUSION: We were able to implant the device without significant complication in all our patients and close PFO effectively. No recurrence of neurologic episode were observed. We conclude that in this initial and intermediate-term follow up, the transcatheter closure of PFO associated with paradoxical embolism using the Amplatzer(R) PFO Occluder is a safe and effective method in prevention of stroke recurrence and there is no significant adverse effect until now. And this procedure may be the treatment choice in patients with the high risk of recurrence ischemic attack. However, in this study, the number of patients included[5 patients(50%) had multiple thromboembolic events] is small and follow-up period is not long. So, we need more clinical cases and long-term clinical follow-up.
Anesthesia, General ; Embolism, Paradoxical* ; Follow-Up Studies ; Foramen Ovale, Patent* ; Humans ; Ischemic Attack, Transient ; Male ; Recurrence ; Stroke

OBJECTIVE: The purpose of this study was to evaluate changes in bone quantity based on bone mineral density (BMD) and bone quality based on trabecular bone score (TBS) in Graves' disease patients after anti-thyroid therapy. RESEARCH DESIGN AND METHOD: This retrospective study included premenopausal female and male patients with Graves' disease who received BMD measurement more than two times during treatment. BMD and thyroid function tests with free thyroxine (FT4), total triiodothyronine (T3), thyroid stimulating hormone (TSH), and TSH receptor antibody (TRAb) levels were collected two times during follow-up. TBS was calculated using TBS insight® software (version 2.1) from dual-energy X-ray absorptiometry images. RESULTS: Thirty Graves' disease patients (17 males, 56%; 13 premenopausal females, 44%) with a mean age of 35.3 ± 9.9 years were included. The mean follow-up period was 20.7 ± 8.5 months. The median levels of FT4, TSH and TRAb improved at follow-up [2.55 ng/dL (Interquartile range (IQR) 2.07-3.78) to 1.28 ng/dL (IQR 1.23-1.39), 0.015 mIU/L (IQR 0.01-0.04) to 0.89 mIU/L (IQR 0.35-1.55), 17.0 IU/L (IQR 5.0-40.3) to 5.0 IU/L (5.0-6.0), respectively; p < 0.001]. Median BMD (lumbar spine) values also improved from 1.118 g/cm² (IQR 1.000-1.119) to 1.167 g/cm² (IQR 1.050-1.219) ( p = 0.001) at follow-up. TBS increased from 1.377 (IQR 1.299-1.422) to 1.390 (IQR 1.327-1.430) after treatment ( p = 0.038). CONCLUSIONS: Both bone quality and density improved after anti-thyroid treatment in premenopausal female and male Graves' disease patients.
Absorptiometry, Photon ; Bone Density* ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Male ; Methods ; Receptors, Thyrotropin ; Research Design ; Retrospective Studies ; Thyroid Function Tests ; Thyrotropin ; Thyroxine ; Triiodothyronine

Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract ; Papilloma* ; Prognosis

Objectives: The aim of this study was to examine the effect of cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) based psychoeducation with mindfulness meditation (PMM) on hazardous drinking (HD) and motivation for change. Methods: The participants were people who received order of lecture due to drunk driving. A total of 75 subjects participated in 6-session CBT/MET based PMM for 3 weeks as order of lecture program. Age, sex, and alcohol related problems (physical symptoms, occupational problem, economic difficulty, use of mental health service, and family conflict), HD, motivation for change and insight into HD, and depressive symptoms were assessed. Results: Compared with before the order of lecture program, the portion of those with HD significantly decreased (86.7% to 50.7%, pConclusions This study demonstrated significant effects of CBT/MET based PMM on HD and motivation for change in drunk drivers. Our findings suggest that integrating approaches from CBT, MET, and mindfulness meditation can contribute to preventing and reducing HD.

PURPOSE: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. MATERIALS AND METHODS: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, > or =4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. RESULTS: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p< or =0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). CONCLUSION: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions > or =4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.
Adult ; Carcinoma, Papillary/pathology/*surgery ; Endoscopy/adverse effects/methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Nodule/pathology/*surgery ; Thyroidectomy/adverse effects/*methods ; Treatment Outcome

BACKGROUND: Several factors associated with human virologic failure in patients with immunodeficiency virus (HIV) infection are low CD4+ cell counts, advanced clinical stage, poor subscribing, subtherapeutic drug levels, etc. Among these factors, poor adherence is one of the leading causes. MATERIALS AND METHODS: We evaluated the adherence to antiretroviral treatment in HIV infected Koreans using questionnaire. We evaluated the factors associated with poor adherence and analyzed the correlation between the adherence to antiretroviral treatment and virologic failure. RESULTS: A total of 49 patients responded to the questionnaire. Of the 49 patients, 26 (53.1%) answered that they had never forgotten to take their medicine, and 23 (46.9%) answered that they had taken all their medications during the last week. The reasons for missed doses were forgetting, being too busy, having adverse side effects, etc. Low CD4+ T cell counts, longer duration of antiretroviral treatment, and longer duration of being diagnosed with HIV infection were associated with poor adherence in HIV infected Koreans (P<0.05). There was correlation between poor adherence and virologic failure in these HIV-infected Koreans (P<0.05). CONCLUSION: Because poor adherence induces treatment failure, monitoring adherence is very important for successful antiretroviral treatment. Questionnaire was a good method for monitoring adherence in HIV infected patients.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Cell Count ; HIV ; HIV Infections ; Humans ; Treatment Failure ; Surveys and Questionnaires

BACKGROUND: Several factors associated with human virologic failure in patients with immunodeficiency virus (HIV) infection are low CD4+ cell counts, advanced clinical stage, poor subscribing, subtherapeutic drug levels, etc. Among these factors, poor adherence is one of the leading causes. MATERIALS AND METHODS: We evaluated the adherence to antiretroviral treatment in HIV infected Koreans using questionnaire. We evaluated the factors associated with poor adherence and analyzed the correlation between the adherence to antiretroviral treatment and virologic failure. RESULTS: A total of 49 patients responded to the questionnaire. Of the 49 patients, 26 (53.1%) answered that they had never forgotten to take their medicine, and 23 (46.9%) answered that they had taken all their medications during the last week. The reasons for missed doses were forgetting, being too busy, having adverse side effects, etc. Low CD4+ T cell counts, longer duration of antiretroviral treatment, and longer duration of being diagnosed with HIV infection were associated with poor adherence in HIV infected Koreans (P<0.05). There was correlation between poor adherence and virologic failure in these HIV-infected Koreans (P<0.05). CONCLUSION: Because poor adherence induces treatment failure, monitoring adherence is very important for successful antiretroviral treatment. Questionnaire was a good method for monitoring adherence in HIV infected patients.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Cell Count ; HIV ; HIV Infections ; Humans ; Treatment Failure ; Surveys and Questionnaires

BACKGROUND: Recently, anti-ganglioside complex (GSC) antibodies were discovered among the various subtypes of Guillain-Barré syndrome. GSC is the novel glycoepitopes formed by two individual ganglioside molecules. CASE REPORT: We present a 36-year-old man with overlap Miller Fisher syndrome and acute bulbar palsy who had anti-GSC antibody that provided diagnostic robustness. CONCLUSION: Anti-GSC testing could be considered important in patients who show atypical manifestation with negative antibody reaction against each constituent ganglioside.
Adult ; Antibodies ; Bulbar Palsy, Progressive ; Gangliosides ; Guillain-Barre Syndrome ; Humans ; Miller Fisher Syndrome

PURPOSE: This study aimed to develop a job description for healthcare managers of metabolic syndrome management programs using task analysis. METHODS: Exploratory research was performed by using the Developing a Curriculum method, the Intervention Wheel model, and focus group discussions. Subsequently, we conducted a survey of 215 healthcare workers from 25 community health centers to verify that the job description we created was accurate. RESULTS: We defined the role of healthcare managers. Next, we elucidated the tasks of healthcare managers and performed needs analysis to examine the frequency, importance, and difficulty of each of their duties. Finally, we verified that our job description was accurate. Based on the 8 duties, 30 tasks, and 44 task elements assigned to healthcare managers, we found that the healthcare managers functioned both as team coordinators responsible for providing multidisciplinary health services and nurse specialists providing health promotion services. In terms of importance and difficulty of tasks performed by the healthcare managers, which were measured using a determinant coefficient, the highest-ranked task was planning social marketing (15.4), while the lowest-ranked task was managing human resources (9.9). CONCLUSION: A job description for healthcare managers may provide basic data essential for the development of a job training program for healthcare managers working in community health promotion programs.
*Administrative Personnel ; Adult ; Attitude of Health Personnel ; Community Health Centers/*manpower ; Focus Groups ; Humans ; Job Description/*standards ; Metabolic Syndrome X/*therapy ; Middle Aged ; Republic of Korea ; Task Performance and Analysis ; Young Adult

BACKGROUND: Photodynamic therapy is a treatment modality which involves the sequential administration of a photosensitizer and light. Topical photodynamic therapy is being increasingly used for superficial non-melanoma skin cancers and their precursors. OBJECTIVE: The purpose of this study was to evaluate the effectiveness and side effects of treating actinic keratosis with photodynamic therapy using a light-emitting diode device and 20% 5-aminolevulinic acid. METHODS: Photodynamic therapy, with a 630+/-50nm light-emitting diode device and 5-aminolevulinic acid, was used to treat 12 lesions of actinic keratosis on 8 patients. The light intensity used was 50mW/cm2 , and the light dose was 100-120J/cm2 . Four weeks after 1 or 2 treatment sessions, the outcome was evaluated by histopathological findings. RESULTS: Complete clearance was achieved in 8 of 12 lesions after a single treatment, and in 3 of 12 lesions after 2 treatment sessions. Only 1 case showed partial response after 2 treatment sessions. Only 2 patients suffered from a stinging sensation when exposed to the light therapy. CONCLUSION: Topical photodynamic therapy using a light-emitting diode is safe and effective in the treatment of actinic keratosis.
Actins* ; Bites and Stings ; Humans ; Keratosis, Actinic* ; Photochemotherapy* ; Phototherapy ; Sensation ; Skin Neoplasms