OBJECTIVE: This study was to investigate the factors that influence the propensity of Koreans in choosing care settings of dementia patients. METHODS: This study analyzed the data from the '2014 Nationwide Survey on Dementia Awareness of Koreans' that was conducted by the National Institute of Dementia. Korean's perception of care burden for dementia was measured with grading on its types. Also its influences on preference for care between facilities and homes were evaluated using multivariate analysis with socio-demographic characteristics. RESULTS: In terms of preferred care settings, respondents preferred facilities over homes in case of themselves and their family, respectively 77.5% and 68.2%. The preference for facilities was significantly influenced by the respondents' age for both themselves and their family. Additionally, the perception of relatively higher emotional and physical burden compared to economic burden significantly influenced preference for facilities for their family. CONCLUSION: Improving public awareness and setting-up a practical social supporting system are needed to reduce emotional and physical burden as well as economic burden of dementia. Furthermore, building up an appropriate and safer communities for dementia patients and their caregivers is much demanded for reducing their burdens.
Caregivers ; Surveys and Questionnaires ; Dementia* ; Humans ; Multivariate Analysis

We report a case of pulmonary edema developed in a 33-year-old female who underwent two-stage bilateral carotid body tumor excision. About 1 month ago, she had undergone a left carotid body tumor excision. After the operation, her tongue was deviated to left side. Bilateral hypoglossal nerve injury was suspected. These injuries should be carefully monitored in patients who will undergo a similar procedure on both sides because a bilateral deficit of the hypoglossal nerve is poorly tolerated, resulting potentially serious pulmonary edema. In recovery room, she became pale and SpO2 was fall down. We reintubated her immediately and the pulmonary edema was treated using a supportive management. She was discharged without any signs of dyspnea or airway obstruction, but hypoglossal nerve injury remained. We discuss the possible etiology of the upper airway obstruction after the neck surgery and review the literatures associated with the pulmonary edema following upper airway obstruction.
Adult ; Airway Obstruction ; Carotid Body Tumor* ; Carotid Body* ; Dyspnea ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Neck ; Pulmonary Edema* ; Recovery Room ; Tongue

Papular elastorrhexis (PE) is a rare connective tissue disease, histopathologically characterized as decreased and fragmented elastic fibers in the reticular dermis, with or without change to the collagen bundles. It presents as small, white, nonfollicular papules predominantly scattered over the chest, shoulders, or back, and is most often seen in females of the second decade. Although all reported cases of PE have been asymptomatic, a 21-year-old woman presented with a one-year history of multiple, small skin-colored papules on the back which were associated with an intermittent itching sensation. Histopathologic examination revealed fragmented elastic fibers with focal homogenization of collagen in the reticular dermis. Therefore, we report a rare case of papular elastorrhexis with "pruritus".
Collagen ; Connective Tissue Diseases ; Dermis ; Elastic Tissue ; Female ; Humans ; Pruritus ; Sensation ; Shoulder ; Thorax ; Young Adult

Noonan syndrome is characterized by short stature, mental retardation, typical facial morphology, webbed neck and congenital heart disease. Noonan syndrome can be inherited in an autosomal dominant manner but all Korean patients with Noonan syndrome have been reported as sporadic cases thus far. In approximately 50-60% of cases, the disease is caused by mutation in the PTPN11 (protein tyrosine phosphatase, nonreceptor type 11) gene on chromosome 12, encoding SHP-2 (Src homology protein-tyrosine phosphatase-2). We have experienced a boy and his father with typical clinical features of Noonan syndrome in whom Asn58Asp mutation of the PTPN11 gene were identified. To the best of our knowledge, this is the first report of genetically confirmed familial Noonan syndrome in Korea.
Chromosomes, Human, Pair 12 ; Fathers ; Heart Diseases ; Humans ; Intellectual Disability ; Neck ; Noonan Syndrome ; Tyrosine

BACKGROUND: Although basal cell carcinoma (BCC) is the most common human skin tumor, with calcification reportedly taking place in about 20% of all BCC cases, the pathogenesis of calcification in BCC has not yet been studied. OBJECTIVE: The purpose of this study was to evaluate factors related to the pathogenesis of calcification in BCC. METHODS: We performed immunohistochemical staining for beta-catenin, frizzled-2, BMP-4, osteopontin, osteocalcin, and osteonectin using frozen skin tissue from 15 cases of BCC with calcification and 11 cases of BCC without calcification. RESULTS: The expression of beta-catenin showed positive in 14 of the 15 cases in BCC with calcification, but negative in all 11 cases of BCC without calcification. The expression of frizzled-2 was observed in 14 of the 15 cases in BCC with calcification, and in 10 of the 11 cases in BCC without calcification. The difference did not reach statistical significance (p=0.236). The expression of BMP-4 was observed in all 26 samples of BCC, but the intensity of expression did not reach statistical significance between the two groups (p=0.293). Furthermore, osteopontin and osteocalcin showed no statistical significance between two the groups (p=0.567, p=0.401). The expression of osteonectin was observed in all of the BCC cases, and was stronger in BCC with calcification than in BCC without calcification (p=0.042). CONCLUSION: We suggest that the calcification in BCC might be related to the increase of beta-catenin expression and that osteonectin might also influence the process of calcification in BCC.
beta Catenin* ; Carcinoma, Basal Cell* ; Humans ; Osteocalcin* ; Osteonectin* ; Osteopontin* ; Skin

BACKGROUND: Cough and hyperdynamic reaction cause considerable discomfort, and they may lead to postoperative surgical complication. To reduce coughing and hemodynamics during emergence, the efficacy of laryngotracheal spraying with lidocaine before intubation is not clear, particularly, in children. We investigated such effect during emergence from general anesthesia, in children. METHODS: Children were studied in a double blind manner: 105 ASA physical status I-II, aged 2-16 yrs, undergoing tonsillectomy and adenoidectomy. Patients were randomly grouped into three (A, B, and C) by the lidocaine spray before endotracheal intubation: 4% lidocaine to the group A (n = 32), 10% lidocaine to the group B (n = 36), and normal saline to the group C (n = 37). The same dose (2 mg/kg) of lidocaine was applied. During emergence, patients were observed their cough and hemodynamics. RESULTS: Lidocaine spray, irrespective of concentration, did not significantly diminish the cough and the hemodynamic reaction across the groups before and after the extubation as well as in the recovery room (P value = 0.44, 0.86, 0.17). CONCLUSIONS: These findings support that the laryngotracheal spraying with lidocaine (2 mg/kg of 4% and 10%) before endotracheal intubation does not reduce the cough and hemodynamic reactions during emergence from general anesthesia in children.
Adenoidectomy ; Anesthesia, General ; Child* ; Cough* ; Hemodynamics* ; Humans ; Incidence* ; Intubation ; Intubation, Intratracheal* ; Lidocaine* ; Recovery Room ; Tonsillectomy

Lichen nitidus (LN) is an uncommon chronic inflammatory skin disease composed of numerous, tiny, shiny, flesh-colored papules that are predominantly observed on the chest, abdomen, glans penis and upper extremities. The distribution of LN is most often localized, but in some cases it can become generalized. Because LN tends to be asymptomatic and presents spontaneous resolution within several years, it usually does not require treatment except in symptomatic, persistent and generalized cases. We describe a 28-yr-old man and a 7-yr-old boy with generalized LN where both cases improved with narrow-band ultraviolet B (NB-UVB) phototherapy plus topical steroid ointment. Both patients noted improvement within the first three treatments and showed almost complete resolution after 18 and 20 treatments, respectively. NB-UVB phototherapy may be an effective alternative therapy for the treatment of generalized LN, even for those patients in their childhood.
*Ultraviolet Therapy ; PUVA Therapy ; Male ; Lichen Nitidus/pathology/*radiotherapy ; Humans ; Child ; Adult

PURPOSE: To assess the usefulness of (99m)Tc-DISIDA scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia. METHODS: DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots. RESULTS: DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis. CONCLUSION: We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.
Biliary Atresia ; Bilirubin ; Cholestasis* ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Female ; Hepatitis ; Humans ; Infant, Newborn ; Liver ; Male ; Sensitivity and Specificity

BACKGROUND: Pericardiocentesis is not routinely recommended in most patients with pericardial effusion (PE), except for patients with cardiac tamponade. However, the long-term follow-up results in patients with clinically not significant PE are few. METHODS: Sixty-five consecutive patients (mean age:57 yrs, 26 males) out of 87 patients with PE, who were clinically not serious, were studied prospectively once in every two month for mean 6 months (2-12 months) without any specific treatment. The amount of PE was measured at the enddiastole period of parasternal long axis view and apical four chamber view. RESULTS: The incidence of insignificant PE in our echocardiographic laboratory is 3.4% (n=87 from 2461). The maximal accumulation site of PE was posterior (n=51, 79%). The next is anterior (n=11, 17%) and right ventricular side (3, 5%). The amount of PE is less (0.37+/-0.17cm vs 0.64+/-0.54cm, p=0.018) in localized PE (n=24, 37%) than that of diffuse form (n=41, 63%), which spreads to more than 2 chambers. The presumptive etiologies of PE were unknown (n=41), heart failure (n=5), myocardial infarction (n=6), viral (n=3), and others (n=10). The amount of PE was decreased from 0.54+/-0.46 cm to 0.30+/-0.26 cm, 0.23+/-0.24 cm, and 0.21+/-0.23 cm 2, 4, and 6 months after intial evaluation, respectively, without any complication. CONCLUSION: The patients with PE, not combining >KERN= Axis, Cervical Vertebra ; Cardiac Tamponade ; Echocardiography ; Follow-Up Studies* ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Pericardial Effusion* ; Pericardiocentesis ; Prospective Studies