Urinary disorders are important factors that affect the quality of life. Urinary incontinence refers to urine leakage against will and is categorized intostress incontinence, urge incontinence, and other types. The prevalence of incontinence increases with aging. Since most patients hesitate talkingabout urinary problems, it is important to proactively ask questions to ensure proper care. The diagnostic approach includes history taking, physicalexamination, and urinalysis. The use of specific questionnaires and voiding diaries is also beneficial. The first management option for patients withincontinence is conservative treatment, especially training for strengthening the pelvic floor muscles. Anti-cholinergic medications and mirabegronare used for treating urge incontinence. To minimize adverse events, starting medications at low doses, with follow-up at short intervals, isrecommended. For treating stress incontinence, surgical approaches like sling surgery are preferred to medications. Primary physicians need to payattention to urinary problems to help older patients address their difficulties and to promote their quality of life.

Background/Aims: Asthma is not a single disease but, rather, a heterogeneous inf lammatory disorder with various pathogenic mechanisms. We analyzed the associations between the cellular profile of sputum and the serum levels of inflammatory mediators/cytokines in a cohort of adult asthmatics. Methods: We recruited 421 adult asthmatic patients. All subjects were classified into four groups according to their sputum cellular profiles: G1, eosinophilic; G2, mixed granulocytic; G3, neutrophilic; and G4, paucigranulocytic. Serum levels of cytokines and mediators including periostin, eosinophil-derived neurotoxin (EDN), S100A9, and folliculin were quantified. Results: Among 421 patients, G1 accounted for 149 (35.4%), G2 for 71 (16.9%), G3 for 155 (36.8%), and G4 for 46 (10.9%). Serum periostin and EDN levels were significantly higher in G1 (p = 0.004, and p = 0.031) than in the others. Serum S100A9 levels were elevated in G2 and G3 (p = 0.008). Serum folliculin levels differed significantly among the four groups, with the highest level in G4 (p = 0.042). To identify G1 from G1 plus G2 groups, the optimal serum cut-off levels were 1.71 ng/mL for periostin, and 1.61 ng/mL for EDN. When these two parameters were combined, the sensitivity was 76.0% and the specificity was 64.3% (area under the curve, 0.701; p = 0.004). Conclusions The serum periostin and EDN levels may be used as predictors to discriminate the eosinophilic asthma group from patients having eosinophilic or mixed granulocytic asthma, and the serum folliculin level is significantly elevated in patients with paucigranulocytic asthma compared to those with different inflammatory cell profile.

No abstract available.
Anaphylaxis* ; Basophils*

BACKGROUND: There is increasing evidence about inflammatory processes in the development of dementia. Therefore, inflammation has been believed to play a pivot role in cognitive decline, Alzheimer's disease (AD), and vascular dementia. High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. It is important to identify modifiable risk factors, which could be used in preventing or delaying the onset of dementia. Therefore, we studied to clarify a clinical role of hs-CRP in AD and VaD. METHODS: This study population consisted of a sample of 102 patients with dementia (54 patients of AD and 48 patients of VaD) and 91 controls. We have investigated hs-CRP levels and cognitive function of each group. Cognitive function was evaluated with Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR) with Sum of Box and Activities of Daily Living (ADL). RESULTS: All subjects with dementia showed higher hs-CRP levels than subjects without dementia. But, there was no significant difference of hs-CRP levels between patients with AD and those with VaD. The odds ratio of patients with AD and VaD by hs-CRP is 2.250 (95% Cl 1.670-3.032) for Alzheimer's disease and 4.0 (95% Cl 2.451-6.529) for vascular dementia. CONCLUSIONS: The result of our study suggests the presence of inflammatory activity is related with dementia, not only AD known to degenerative disease but also VaD associated with cerebrovascular disease. However, we could suggest that dementia with cerebrovascular lesions is more related with inflammatory activity than AD.
Activities of Daily Living ; Alzheimer Disease ; C-Reactive Protein ; Dementia ; Dementia, Vascular ; Humans ; Inflammation ; Odds Ratio ; Risk Factors

OBJECTIVES: The purpose of this study is to investigate a cut-off value for screening children with ADHD in community based sample using the Korean Child Behavior Checklist (K-CBCL) and the Korean ADHD Rating Scale (K-ARS). METHODS: Children aged 6 to 8 (n=661) participated in this study. The K-CBCL and the K-ARS were used as the screening instruments. Diagnoses were confirmed through the Diagnostic Interview Schedule for Children Version IV (DISC-IV). RESULTS: Of the 189 subjects who underwent the DISC-IV, 26 subjects were diagnosed as ADHD. In the K-CBCL, scores in the attention problems, externalizing problems and total behavioral problems were positively correlated with the total score of the K-ARS. The K-ARS-Parent version (K-ARS-P) and above three scales in the K-CBCL showed significant screening validity in the ROC curve analysis. The reasonable level of sensitivity, specificity, and negative predictive value were obtained in the total scores > or =90th percentile in the K-ARS-Parent and > or =60T scores in the K-CBCL attention problems. The optimal level of specificity, positive predictive value and negative predictive value were obtained when combined the K-CBCL (> or =60T scores in the attention problems and > or =63T scores in the total problems) and the total scores > or =90th percentile in the K-ARS-P. CONCLUSION: The combined use of the K-CBCL and the K-ARS-P may serve as useful screening methods for ADHD children.
Aged ; Appointments and Schedules ; Checklist ; Child ; Child Behavior ; Humans ; Mass Screening ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

OBJECTIVE: To evaluate the feasibility of laparoscopic salpingectomy using one-port in tubal pregnancy compared to conventional laparoscopic surgery. METHODS: From June 2008 to June 2011, 63 women were treated with laparoscopic salpingectomy due to tubal pregnancy, which was diagnosed by ultrasonography. These patients were divided into two groups. Of these 63 patients, 32 women were treated with conventional laparoscopic salpingectomy (CLS) in group I, 31 women underwent laparoscopic salpingectomy using one port (OPLS) in group II. In group I, rigid 0degrees or 30degrees, 10 mm laparoscope, rigid instruments were used. In group II, 30degrees, 10 mm laparoscope, rigid or flexible angulated tip instruments were used during the surgery. We reviewed and compared clinical characteristics, clinical outcomes of these patients. RESULTS: Patients in Group I were compatible with the patients in group II in clinical characteristics. Clinical outcomes were not different between two groups in terms of Hemoglobin change (g/dL), hospital stay (days), hemoperitoneum (mL), transfusion. Mean operative time was significantly longer in group II (59.7+/-15.7 min vs. 46.5+/-15.0 min, p=0.001). The mean length of skin incision was obviously shorter in group II; the difference was highly statistically significant (15.5+/-3.0 mm vs 23.5+/-3.0 mm, p<0.001). CONCLUSION: It seems that OPLS is feasible alternative to CLS to treat hemodynamically stable patients without complications. Additionally, this technique also results in better cosmetic outcomes than CLS. Randomized prospective clinical studies with larger scale are necessary in the future to confirm these results.
Cosmetics ; Female ; Hemoglobins ; Hemoperitoneum ; Humans ; Laparoscopes ; Laparoscopy ; Length of Stay ; Operative Time ; Pregnancy ; Pregnancy, Tubal ; Salpingectomy ; Skin

A 34-year-old female underwent emergency cesarean section with general anesthesia. The patient was a para 1-0-0-1, referred at 39 weeks in labor with known severe aortic stenosis due to a bicuspid aortic valve. She has been treated with digoxin and furosemide for 5 years. At first, she tried a normal spontaneous vaginal delivery, but dyspnea was aggravated during delivery, so an emergency operation was decided. Anesthesia was induced using ketamine 80 mg, fentanyl 50 microgram and vecuronium 6 mg and maintained with 50% nitrous oxide in oxygen. After fetal delivery and infusion of oxytocin, the systolic blood pressure decreased to 60 mmHg or less, so we injected phenylephrine 100 microgram bolus. However, the blood pressure did not increase, so we injected phenylephrine continuously ( 0.5 microgram/kg/ min). One month postpartum, echocardiography was done. The left ventricle-aortic pressure gradient was 140 mmHg, so the cardiologist recommended an aortic valve replacement operation. She refused the operation and has been medicated with digoxin and furosemide up to date.
Adult ; Anesthesia ; Anesthesia, General* ; Aortic Valve ; Aortic Valve Stenosis* ; Bicuspid ; Blood Pressure ; Cesarean Section* ; Digoxin ; Dyspnea ; Echocardiography ; Emergencies* ; Female ; Fentanyl ; Furosemide ; Humans ; Ketamine ; Nitrous Oxide ; Oxygen ; Oxytocin ; Phenylephrine ; Postpartum Period ; Pregnancy ; Vecuronium Bromide

Thyroid antibodies are frequently observed in urticaria patients, but their roles in urticaria are not clearly elucidated. We investigated the role of serum specific IgE to thyroid peroxidase (TPO) in patients with aspirin intolerant acute urticaria (AIAU) and aspirin intolerant chronic urticaria (AICU). We recruited 59 AIAU and 96 AICU patients with 69 normal controls (NC). Serum specific IgE to TPO was measured by manual direct ELISA, and CD203c expressions on basophil with additions of TPO were measured to prove a direct role of TPO in effector cells. The prevalences of serum specific IgE to TPO were significantly higher in AIAU (15.2%) and AICU groups (7.5%) compared to NC (0%, P=0.018: P=0.013, respectively). Flow cytometry showed CD203c induction in a dose dependent manner with serial additions of TPO in some AIAU and AICU patients having high specific IgE to TPO. Our findings show that the prevalence of serum specific IgE to TPO was significantly higher in both AIAU and AICU patients than in NC. It is suggested that specific IgE to TPO play a pathogenic role in AIAU and AICU.
Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Aspirin/*adverse effects ; Autoantibodies/immunology ; Basophils/drug effects/*immunology ; Humans ; Immunoglobulin E/blood/*immunology ; Iodide Peroxidase/blood/*immunology ; Urticaria/*chemically induced/*immunology/pathology

PURPOSE: There are several reports that the risk of development of leukemias is much higher in Down syndrome (DS) children than in non DS children. But there are a few reports about the clinical features of leukemia in Down syndrome and the prognosis in Korea. The object of this study is to evaluate clinical features, treatment results and the prognosis of leukemia of Down syndrome patients. METHODS: We conducted retrospective reviews in 10 children with leukemia of Down syndrome who were admitted to the Department of Pediatrics in Yonsei University Hospital between March 1986 and December 2000. We analyzed the clinical features, laboratory findings and survival rates. RESULTS: A male to female ratio was 1:1.25. Median age at diagnosis was 2 years 8 months. Initial symptoms were hepatosplenomegaly, petechiae, fever and upper respiratory infection symptoms. The number of patients by the type was as followed:acute myeloid leukemia (AML) 7 (70%), acute lymphocytic leukemia 2 (20%), acute mixed lineage leukemia 1 (10%). There were 4 cases of M7 subtype in AML. The median peripheral blood cell counts were as followed; leukocyte was 41,000/muL, hemoglobin was 8.7 g/dL, the platelet was 103,000/muL. The five years event free survival rate after diagnosis was 87.5% (7/8). The one patient relapsed and another one patient died of cardiac anomaly. CONCLUSION: There seemed to be several differences of clinical features between DS leukemia and non DS leukemia, especially prognosis. Multi-centered well organized study should be done to confirm our observation.
Blood Cell Count ; Blood Platelets ; Child ; Chromosomes, Human, Pair 21 ; Diagnosis ; Disease-Free Survival ; Down Syndrome* ; Female ; Fever ; Humans ; Korea ; Leukemia* ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Leukocytes ; Male ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis* ; Purpura ; Retrospective Studies ; Survival Rate

BACKGROUND: The hypothesis that subcortical disinhibition is the reason for etomidate-induced myoclonus suggest that drugs acting on the subcortical area may reduce myoclonus. To verify the hypothesis, premedication with placebo, etomidate of a small dosage, midazolam and fentanyl were compared. METHODS: Sixty ASA physical status I or II patients undergoing elective surgery were allocated into four groups. All groups were induced with etomidate 0.3 mg/kg and vercuronium 0.1 mg/kg and maintained with 50% N2O and 1.5-2% enflurane. Group I (n = 15) received normal saline 3 ml 5 minutes before the etomidate 0.3 mg/kg administration, group II (n = 15) received 0.05 mg/kg etomidate 50 seconds before the etomidate 0.3 mg/kg administration, group III received midazolam 0.05 mg/kg 5 minutes before the etomidate 0.3 mg/kg and group IV received 2 microgram/kg fentanyl 5 minutes before the etomidate 0.3 mg/kg. In all patients, the grade, starting time, maintenance time of myoclonus and vital signs were checked and compared between the four groups. RESULTS: In group IV, myoclonus did not develope except in one patient and there were no differences in the incidence of myoclonus between the others. All premedicating drugs do not affect vital signs. CONCLUSIONS: We find that fentanyl reduces the incidence of etomidate-induced myoclonus but midazolam and a small dose of etomidate are not effective.
Anesthesia* ; Enflurane ; Etomidate* ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Myoclonus* ; Premedication ; Vital Signs