Parkinsonism is a very rare complication of phenytoin. The authors experienced a 71-year-old man who presented progressive cognitive decline, postural tremor, bradykinesia and gait disturbance. Laboratory test and brain imaging revealed no abnormality that commonly causes parkinsonism. The only abnormal finding was elevation of serum phenytoin above the therapeutic level. The patient showed marked improvement of symptoms by reduction of phenytoin dosage. Here we report a case of phenytoin induced parkinsonism.
Aged ; Gait ; Humans ; Hypokinesia ; Neuroimaging ; Parkinsonian Disorders ; Phenytoin ; Tremor

OBJECTIVE: The goal of the present study was to evaluate demographic and clinical factors that affect the intention to participate in commonly-conducted research in patients with schizophrenia. METHODS: Thirty-four outpatients with a diagnosis of schizophrenia were enrolled in this study. They were asked whether they would have any intention to participate in four imaginary studies: a simple questionnaire, a genetic study, a study of complex tasks and a risky study. We analyzed the differences in general psychopathology, insight and demographic characteristics of the participants according to their responses (acceptance or refusal) to the four proposed studies. RESULTS: Younger and better-educated patients tended to decline participation in a risky study. Patients with a longer duration of regular psychiatric follow-ups tended to willingly participate in the simple questionnaire. There were no overall statistical differences in general psychopathology and insight between patients who agreed or declined to participate in studies. CONCLUSION: Age and education level may be factors that influence decisions to participate in schizophrenia studies. Further research is needed to confirm and expand on the current findings.
Demography ; Follow-Up Studies ; Humans ; Informed Consent ; Intention ; Outpatients ; Patient Participation ; Pilot Projects ; Psychopathology ; Surveys and Questionnaires ; Research Subjects ; Schizophrenia

PURPOSE: Intracavernous injection (ICI) was once the cornerstone of treatment for erectile dysfunction (ED). This study was designed to investigate how the treatment of ED has changed since introduction of oral sildenafil. MATERIALS AND METHODS: In a total of 574 new ED (mean duration 2.9 years) patients with a mean age of 52.6 11.8 years, associated diseases, the cause and duration of ED, and the treatment used initially and after 6 months were investigated. RESULTS: The ED was psychogenic in 40.7% of the men. The most common cause of organic ED was vascular (18.1%) followed by diabetes (15.9%). The associated diseases were hypertension (19.9%), diabetes mellitus (16.5%), trauma and surgery (5.5%), endocrinologic (4.7%), coronary artery (1.6%), and hypercholesterolemia (1.1%). The initial treatment modality was an oral sildenafil in 68.7%, ICI in 11.3%, testosterone replacement in 2.7%, implantation of penile prostheses in 0.8%, and wait and see in 16.5%. Six months later, excluding the patients lost to follow-up, 73.4% of the patients were using oral sildenafil and 20.5% were using ICI. CONCLUSIONS: Oral sildenafil has largely replaced intracavernous injection for the initial treatment of erectile dysfunction.
Coronary Vessels ; Diabetes Mellitus ; Erectile Dysfunction* ; Humans ; Hypercholesterolemia ; Hypertension ; Lost to Follow-Up ; Male ; Penile Prosthesis ; Testosterone ; Sildenafil Citrate

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiac arrhythmia due to autonomic dysfunction. The aim of this study was to elucidate the effect of OSAS on the QT interval and the efficacy of continuous positive airway pressure (CPAP) treatment on a prolonged QT interval. METHODS: From March 2007 to January 2008, 13 patients diagnosed as OSAS received CPAP treatment. Ten age- and sex-matched healthy controls were enrolled, and nighttime polysomnography was performed. We analyzed the full-night electrocardiogram.which is one of the elements of nighttime polysomnography.in all patients and controls. RESULTS: In the patient group, the QTc interval was 0.380+/-0.45 ms (mean+/-SD) before CPAP treatment and 0.368+/-0.32 ms during CPAP treatment. In the control group, the QTc interval was 0.348+/-0.26 ms. The QTc interval did not differ between OSAS patients and controls (p=0.143), but it did significantly shorten between before and after CPAP treatment (p=0.047). CONCLUSIONS: This study suggests that CPAP treatment can improve QTc prolongation and thereby prevent future ventricular arrhythmia.
Arrhythmias, Cardiac ; Continuous Positive Airway Pressure ; Humans ; Polysomnography ; Sleep Apnea, Obstructive

OBJECTIVES: Schizophrenic patients have been shown to be impaired in both emotional self-awareness and recognition of others' facial emotions. Alexithymia refers to the deficits in emotional self-awareness. The relationship between alexithymia and recognition of others' facial emotions needs to be explored to better understand the characteristics of emotional deficits in schizophrenic patients. METHODS: Thirty control subjects and 31 schizophrenic patients completed the Toronto Alexithymia Scale-20-Korean version (TAS-20K) and facial emotion recognition task. The stimuli in facial emotion recognition task consist of 6 emotions (happiness, sadness, anger, fear, disgust, and neutral). Recognition accuracy was calculated within each emotion category. Correlations between TAS-20K and recognition accuracy were analyzed. RESULTS: The schizophrenic patients showed higher TAS-20K scores and lower recognition accuracy compared with the control subjects. The schizophrenic patients did not demonstrate any significant correlations between TAS-20K and recognition accuracy, unlike the control subjects. CONCLUSIONS: The data suggest that, although schizophrenia may impair both emotional self-awareness and recognition of others' facial emotions, the degrees of deficit can be different between emotional self-awareness and recognition of others' facial emotions. This indicates that the emotional deficits in schizophrenia may assume more complex features.
Affective Symptoms ; Anger ; Humans ; Schizophrenia

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI x %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 microM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 microM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 microM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 microM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.
Adenosine Diphosphate ; Blood Platelets* ; Coronary Artery Disease ; Flow Cytometry ; Fluorescein ; Fluorescence ; Glycoproteins* ; Humans ; Platelet Function Tests

OBJECTIVES: The present study was designed to assess the reliability and validity of Korean version of Family Questionnaire (FQ-K), a brief questionnaire measuring expressed emotion (EE). METHODS: A sample of 84 first-order relatives of schizophrenics completed the FQ-K and the data were analyzed for internal consistency and factor structure. Additionally non-random subset of participants (n=34) refilled FQ-K after two weeks for testretest reliability and naturalistic follow-up data of 36 were obtained for any re-hospitalization events to assess predictive validity. RESULTS: Internal consistency of FQ-K was good (Cronbach's alpha=.819) and principal component factor analysis revealed the two-factor structure (criticism and emotional overinvolvement) identical to previously reported for the FQ. The FQ-K also showed reasonable test-retest reliability and excellent predictive validity was indicated in that outcome of re-hospitalization was superior for low expressed emotion patients at six-month naturalistic follow-up. CONCLUSION: The Korean version of FQ proved to be a reliable and valid instrument measuring expressed emotion in relatives of Korean patients with schizophrenia.
Expressed Emotion* ; Follow-Up Studies ; Humans ; Surveys and Questionnaires* ; Reproducibility of Results* ; Schizophrenia

Laryngeal amyloidosis is a rare disease that was first documented in 1875. The incidence of the larynx limited amyloidosis is less than 1% of all benign lesions of larynx. It may occur as primary or secondary to other diseases. Generalized secondary amyloidosis is very rare among them. It is a condition characterized by the extracellular deposition of homogenous, eosinophilic, proteinous material in the form of fibrils. The aim of treatment is to maintatin or improve voice quality and to maintain laryngeal airway. We report a case of laryngeal amyloidosis of AL (amyloid light chain) type that was treated with KTP laser (potassium titany phosphate laser).
Incidence

PURPOSE: Accurate clinical diagnosis of acute appendicitis is more difficult in children since they may not be able to communicate their complaints adequately, and findings on physical examination may be nonspecific.The uncertainty in diagnosis may lead to a delay of surgery or to unnecessary laparotomy. Prompt diagnosis is important due to their complications such as perforation, abscess formation, and peritonitis. The authors conducted this study in order to find out usefulness of ultrasonography in diagnosis of acute appendicitis in children. METHODS: The authors was performed ultrasonographical examination to 290 children with abdominal pain under the age of 15 during a recent 16-months period from January 1994 to April 1995. High-resolution ultrasonography was used according to the graded compression method. The ultrasonographic findings were correlated with pathologic outcome in 87 cases. RESULTS: 1) Among 290 patients with abdominal pain, acute appendicitis was 81 cases (27.9%), and there were mesenteric lymphadenitis, terminal ileitis, intussusception, acute gastroenteritis, and nonspecific findings. 2) Sex ratio of acute appendicitis was 1.53:1. The acute appendicitis was occurred 13.6% in under the age of 5 and 86.4% in over the age of 6. Mean age was 10.6 3) The most frequent symptom was abdominal pain followed by vomiting, fever, nausea, and diarrhea. 4) Leukocytosis (>10,000/cu.mm) was occurred in 71 of 81 (87.7%) cases of acute appendicitis and 24 of 28 (85.7%) cases of acute appendicitis with perforation. 5) The perforation rate was higher in delayed diagnosis and in younger children. 6) Ultrasonography had a sensitivity of 97.5%, specificity of 96.2%, positive predictive value of 90.8%, and negative predictive value of 99.0% on diagnosis in acute appendicitis. CONCLUSIONS: Upon the above results, the authors were able to conclude that graded compression ultrasonography had high sensitivity and specificity and was useful for the diagnosis of acute appendicitis in children. And the ultrasonography can be applied as rapid, noninvasive, and well-tolerated investigation. So, it has diagnostic value as screening test in children whose chief complaint is abdominal pain.
Abdominal Pain ; Abscess ; Appendicitis* ; Child* ; Crohn Disease ; Delayed Diagnosis ; Diagnosis* ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Intussusception ; Laparotomy ; Leukocytosis ; Mass Screening ; Mesenteric Lymphadenitis ; Nausea ; Peritonitis ; Physical Examination ; Sensitivity and Specificity ; Sex Ratio ; Ultrasonography* ; Uncertainty ; Vomiting

Spontaneous intracranial hypotension (SIH) results from spontaneous cerebral spinal fluid leakage, of unknown etiology, at the level of the spine. Physicians' unfamiliarity with SIH and a its varied clinical and radiographic manifestations may contribute to a delayed or erroneous diagnosis. We report an SIH patient whose subdural hematoma (SDH) clinically mimicked meningitis, but who recovered 1 week later, without any neurologic deficit, after an epidural blood patch (EBP) treatment.
Blood Patch, Epidural ; Hematoma, Subdural ; Humans ; Intracranial Hypotension ; Meningitis ; Neurologic Manifestations ; Spine