It is known that the activated peripheral T lymphocytes are increased in patients with autoimmune disorders such as systemic lupus erythematosis, rheumatoid arthritis, multiple sclerosis and autoimmune thyroiditis, but not in the patients with myasthenia gravis on previous studies. We investigated the subsets of T cells in peripheral blood of the patients with myasthenia gravis using flow cytometric analysis. Forty-three patients of myasthenia gravis who were not on steroid or other immunosuppressants were chosen, and thirty-six age-matched healthy persons were evaluated as controls. The peripheral blood mononuclear cells from patients and controls were stained with FITC or PE-conjugated monoclonal antibodies to several surface molecules expressed on T cells within 6 hours after collection. The samples were analysed by flow cytometry within 24 hours. In patients with myasthenia gravis, the expressions of DR and CD25 molecules on the T lymphocytes were increased significantly compared to those of the control group. The expression of CD25 was increased on CD4+ T cells, but not on CD8+ T cells . The expression of DR molecule was increased on CD8+ T cells, but not on CD4+ T cells. Therefore we suggest that the activated T cells are increased in myasthenia gravis and CD25 surface markers on CD4+ T cells may be a more sensitive indicator of immune status.
Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Flow Cytometry ; Fluorescein-5-isothiocyanate ; Humans ; Immunosuppressive Agents ; Multiple Sclerosis ; Myasthenia Gravis* ; Receptors, Interleukin-2 ; T-Lymphocyte Subsets* ; T-Lymphocytes ; Thyroiditis, Autoimmune

PURPOSE: The purpose of this study was to evaluate Korean advance directives (K-AD) by examining the degree of adults' acceptance and reliability of the directive itself. METHODS: Survey was performed with 181 adults aged 20 or older who were recruited from three regions. A questionnaire used to examine the participants' acceptance of their K-AD in terms of visual analogue scale score of complexity, difficulty, necessity, satisfaction, recommendation. Then, a retest was carried out by asking participants to write up a K-AD again to confirm the reliability of the directives. RESULTS: On a scale of 100, the average acceptance score was 70 or above, which represents rather high level of acceptance in all five categories. The test-retest reliability kappa values ranged from 0.592 to 0.950, and the conformity degree was moderate or high. Regarding K-AD components such as values, treatment preference, proxy appointment, differences among age groups were observed in each component. CONCLUSION: The results of this study suggest that K-AD is a feasible instrument to analyze its acceptability and reliability for adult population. K-AD could be utilized to help people make their own decision on their end-of-life care. Further studies are needed to confirm this study results and promote widespread use of K-AD.
Adult ; Advance Directives* ; Feasibility Studies ; Humans ; Proxy ; Reproducibility of Results ; Terminal Care

To examine attitudes and practice patterns of primary care physicians in health promotion and to probe factors associated with active involvement, a nation widecross-sectional postal questionnaire survey of randomly sampled Korean family physicians and internists was performed. The areas of health promotion examined were; smoking, alcohol consumption, stress, exercise, and diet. Overall response rate was 38.0% and an interview survey of sub-samples of non-responders found no differences in socio-demographic characteristics or survey results versus original responders, except for the rate of collecting information on smoking and diet. Smoking cessation was considered important by 92% of responders, while other lifestyle factors were considered important by less than 70%. Approximately 80% of responders believed in effectiveness of lifestyle counseling, except for stress. The frequency of collecting information, providing counseling, and the level of preparedness to undertake counseling were higher for smoking and alcohol than for other factors. Beliefs in effectiveness of health promotion and preparedness to undertake counseling were positively associated with frequency of information collection and providing counseling, even after adjusting for socio-demographic factors. Efforts should be made to change the physicians perception of effectiveness and importance of health promotion, and to improve physician's preparedness to actively intervene.
Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking ; *Attitude of Health Personnel ; Cross-Sectional Studies ; Diet ; Exercise ; Female ; *Health Promotion ; Human ; Korea ; Male ; Middle Aged ; *Physician's Practice Patterns ; *Physicians, Family ; Questionnaires ; Random Allocation ; Smoking ; Stress ; Support, Non-U.S. Gov't

Nemaline myopathy is a rare congenital m opathy, characterized by nonprogressive or slowely progressive muscle weakness associated with rod-like structures in muscle fibers and characteristic dysmorphic features. We report the first farnilial nemaline myopathy in two generations of the same family, confirmed by muscle biospy in an 11-year-old boy and his mother. The patients had hypotonia and slowly progressive muscle weakness of the four limbs associated with characteristic facial dysmorphism and skeletal deformities. Light and electron microscopic study of a muscle biopsy showed numerous nemaline rods in both patients.
Biopsy ; Child ; Congenital Abnormalities ; Extremities ; Family Characteristics ; Humans ; Male ; Mothers ; Muscle Hypotonia ; Muscle Weakness ; Myopathies, Nemaline*

Bilateral hypoglossal nerve palsy is a rare clinical presentation. We report a case of central skull base osteomyelitis (SBO) presenting with complete tongue paralysis in a 53-year-old man who was not diabetic or immunocompromised. Magnetic resonance imaging demonstrated characteristic features including abnormal contrast enhancement in the clivus (T1-weighted images). Blood tests revealed elevated acute-phase reactants and leukocytosis, which prompted prolonged antibiotic treatment. He responded well to the antibiotics, which together with typical clinical and imaging findings led to the diagnosis of bacterial SBO.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Cranial Fossa, Posterior ; Hematologic Tests ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Leukocytosis ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Paralysis ; Skull ; Skull Base ; Tongue

OBJECTIVE: To explore whether the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) can be used to screen for dementia or mild cognitive impairment (MCI) in less educated patients with Parkinson's disease (PD). METHODS: We reviewed the medical records of PD patients who had taken the Korean MMSE (K-MMSE), Korean MoCA (K-MoCA), and comprehensive neuropsychological tests. Predictive values of the K-MMSE and K-MoCA for dementia or MCI were analyzed in groups divided by educational level. RESULTS: The discriminative powers of the K-MMSE and K-MoCA were excellent [area under the curve (AUC) 0.86–0.97] for detecting dementia but not for detecting MCI (AUC 0.64–0.85). The optimal screening cutoff values of both tests increased with educational level for dementia (K-MMSE < 15 for illiterate, < 20 for 0.5–3 years of education, < 23 for 4–6 years, < 25 for 7–9 years, and < 26 for 10 years or more; K-MoCA < 7 for illiterate, < 13 for 0.5–3 years, < 16 for 4–6 years, < 19 for 7–9 years, < 20 for 10 years or more) and MCI (K-MMSE < 19 for illiterate, < 26 for 0.5–3 years, < 27 for 4–6 years, < 28 for 7–9 years, and < 29 for 10 years or more; K-MoCA < 13 for illiterate, < 21 for 0.5–3 years, < 23 for 4–6 years, < 25 for 7–9 years, < 26 for 10 years or more). CONCLUSION: Both MMSE and MoCA can be used to screen for dementia in patients with PD, regardless of educational level; however, neither test is sufficient to discriminate MCI from normal cognition without additional information.
Cognition ; Cognition Disorders* ; Dementia ; Education ; Humans ; Mass Screening* ; Medical Records ; Methylenebis(chloroaniline)* ; Mild Cognitive Impairment ; Neuropsychological Tests ; Parkinson Disease*

Bartter's syndrome is characterized by hyperreninemia, hyperaldosteronism, hypokalemic hypochlorenlic alkalosis, normal blood pressure, juxtaglomerular apparatus hyperplasia, general weakness, and muscle weakness. We experienced a case of hypokalemic myopathy associated with Bartter's syndrome in 15 years old male. He had experienced paroxysmal muscle weakness without sensory change and myalgia since 10 years old. Subsequently, he had complaints of progressive muscle weakness, especially proximal muscles. Prominent juxtaglomerular apparatus with cellular proliferation biopsy was seen in the kidney. And there were mild perivascular inflammatory cell infiltration, small degenerating and/or regenerating muscles fibers, and normal muscle fiber distribution without evidence of chronic myopathy in the muscle biopsy. The patient was sucessfully managed with indomethacin and oral potassium chloride.
Adolescent ; Alkalosis ; Bartter Syndrome* ; Biopsy ; Blood Pressure ; Cell Proliferation ; Child ; Humans ; Hyperaldosteronism ; Hyperplasia ; Indomethacin ; Juxtaglomerular Apparatus ; Kidney ; Male ; Muscle Weakness ; Muscles ; Muscular Diseases* ; Myalgia ; Potassium Chloride

BACKGROUND: Falling in elderly has caused high mortality and morbidity rates. But research papers about falling in elderly are rate in Korea. We examined preventive methods from falling in institutionalized elderly. METHODS: Subjects were 163 older adults residing in a nursing home. Investigators interviewed the subjects by questionnaries about falling, associated factors, environmental factors, and change after falling during last one year. We examined geriatric depression scale(GDS), mini mental status exam-Korea(MMSEK), Katz`s activities of daily living(ADL), Lawton`s instrumental activities of living. Also, we reviewed medical record. We use the student t-test and chi-sqrare test. RESULTS: The total number of 152 subjects were consisted of 69 men and 83 women, with the mean age of 78.8. 30.3% of subjects have experienced falling during last one year, 57.2% of them have had fear of falling, and subjects with gait abnormality were 38.8% Falling occurred most commonly in summer (32.6%) around 2pm(27.7%) on the road(26.1%), because of tripping over(37.3%) during walking (32.3%), on cement(50.5%), with slippers on (56.5%). The injured subjects by falling were 84.8% and serious injuries(fracture, sutured laceration, joint dislocation or sprain, head injury with altered consciousness, hospitalization) were 19.6%. Injuried part of the body is most common in leg (46.2%) 30.4% of subjects visited hospital or emergency room after falling. Falling resulted in decreasing activity in 52.2% of subject. The factors that were significantly associated with falling were fear of falling (p<0.05), depression (p<0.05). Past history of falling, impairment of cognitive function, dizziness were weakly associated with falling. But age, hearing visual acuity, gait abnormality, ADL, anemia, degenerative arthritis were not associated with falling. CONCLUSIONS: The prevalence of falling in elderly was high. Fear of falling and depression were significantly associated with falling. Activity is decreased after falling.
Activities of Daily Living ; Adult ; Aged* ; Anemia ; Consciousness ; Craniocerebral Trauma ; Depression ; Dislocations ; Dizziness ; Emergency Service, Hospital ; Female ; Gait ; Hearing ; Humans ; Joints ; Korea ; Lacerations ; Leg ; Male ; Medical Records ; Mortality ; Nursing Homes* ; Nursing* ; Osteoarthritis ; Prevalence* ; Research Personnel ; Sprains and Strains ; Visual Acuity ; Walking

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.
Arm ; Brain Stem ; Clonazepam ; Dyskinesias ; Humans ; Myoclonus* ; Phenytoin ; Spinal Cord

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.
Arm ; Brain Stem ; Clonazepam ; Dyskinesias ; Humans ; Myoclonus* ; Phenytoin ; Spinal Cord