STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

Pseudoxanthoma elasticum (PXE)-like disorder with multiple coagulation factor deficiency is a genetic disease characterized by dystrophic mineralization of the connective tissue in multiple organs such as the skin, arteries, and retina. Patients with this disorder have excessive folding and sagging of the skin with loss of recoil, as well as coagulopathy. Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract, which primary affects the small intestine, often leading to malnutrition. Here, we describe the case of a 25-year-old woman who presented with these diseases. We found that nutrient deficiency due to long-term Crohn's disease aggravated the coagulopathy associated with PXE-like disorder.
Adult ; Arteries ; Blood Coagulation Factors* ; Connective Tissue ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Malnutrition ; Pseudoxanthoma Elasticum ; Retina ; Skin

A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Night-time hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.
Aged ; Airway Obstruction ; Anoxia ; Diagnosis ; Humans ; Hypotension, Orthostatic ; Korea ; Male ; Multiple System Atrophy* ; Parkinsonian Disorders ; Sleep Apnea, Central ; Tracheostomy ; Ventilation ; Vocal Cord Paralysis*

A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Night-time hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.
Aged ; Airway Obstruction ; Anoxia ; Diagnosis ; Humans ; Hypotension, Orthostatic ; Korea ; Male ; Multiple System Atrophy ; Parkinsonian Disorders ; Sleep Apnea, Central ; Tracheostomy ; Ventilation ; Vocal Cord Paralysis

We present a case of a 64-year-old woman with acute myeloid leukemia who developed a hepatic abscess during the neutropenic period after induction chemotherapy. To treat the abscess, meropenem and ciprofloxacin were administered to target Klebsiella pneumoniae and percutaneous drainage performed. As a result, the patient's fever and c-reactive protein (CRP) subsequently improved. After six weeks of antibiotic therapy, an abdominal computed tomography scan revealed remains of the liver abscess as well as an ileus in the small bowel. Molds from the Mucor genus were cultured from repeated liver abscess drainage and an abscess wall biopsy confirmed hepatic mucormycosis. Along with administration of amphotericin-B deoxycholate for four weeks, we performed lobectomy for hepatic mucormycosis and small bowel resection for a suspected small bowel mucormycosis. After these operations, the patient received liposomal amphotericin B for three weeks and was then maintained with oral posaconazole for more than four weeks. Our case report suggests that hepatic mucormycosis should be considered when a hepatic abscess exhibits a retarded response to antibacterial agents, especially for patients with risk factors. In addition, because an isolated hepatic mucormycosis is infrequent, a thorough search for the extent of the disease is necessary before surgical resection.
Abscess ; Amphotericin B ; Anti-Bacterial Agents ; Biopsy ; C-Reactive Protein ; Ciprofloxacin ; Deoxycholic Acid ; Drainage ; Female ; Fever ; Fungi ; Humans ; Ileus ; Induction Chemotherapy ; Klebsiella pneumoniae ; Leukemia, Myeloid, Acute ; Liver Abscess ; Mucor ; Mucormycosis ; Risk Factors ; Thienamycins ; Triazoles

The Clinical Research Center for Dementia of South Korea (CREDOS), a nation-wide clinical dementia research group, has prepared clinical practice guidelines (CPG) for dementia tailored to the Korean population. In this article, a summary of the CREDOS CPG is presented with the Korean and English version of full report included in the appendix. The CREDOS CPG in intended not only for psychiatrists and neurologists, but also internists, family physicians, and other primary care physicians involved in the prevention and early diagnosis of dementia. While our CPG for dementia mainly covers Alzheimer's disease (AD) and vascular dementia (VaD), it also includes mild cognitive impairment (MCI) and vascular MCI, which are currently known to be the preclinical stages of AD or VaD, respectively, with emphasis placed on early diagnosis. The CREDOS CPG aims to achieve the following goals by developing CPG for dementia: to establish evidence-based, objective and clear clinical standards for dementia; to improve the clinical decision-making process for patients with dementia; to provide scientific and systematic scales to aid in the work of dementia specialists; to suggest comprehensive and systematic healthcare services tailored to each dementia subtype. The CREDOS CPG focuses on diagnosis and evaluation of clinical practice available domestically, and provides useful concepts of dementia. Its emphasis is on etiologies and epidemiology, diagnostic criteria and evaluation, neuropsychological tests, behavioral and psychological symptoms, the activities of daily living, laboratory tests, and brain imaging.
Activities of Daily Living ; Alzheimer Disease ; Appendix ; Delivery of Health Care ; Dementia ; Dementia, Vascular ; Early Diagnosis ; Humans ; Mild Cognitive Impairment ; Neuroimaging ; Neuropsychological Tests ; Physicians, Family ; Physicians, Primary Care ; Psychiatry ; Republic of Korea ; Weights and Measures

PURPOSE: Paragonimiasis is infectious disease occurred by Paragonimus Westermani, which invades into human body as a final host. Habitual eating the freshwater crab or crawfish unboiled is one of the reason of infection. Paragonimiasis raged in 1970s in Korea, Japan, China and other Asian countries but the incidence decreased rapidly. Once people eat infected second host, parasite penetrates the duodenal wall and migrates to the lung. During this migration period, the parasite can migrate to other organ, such as brain, spinal cord, liver and subcutaneous tissue, but the cases are rarely reported. The objective of our study is to present our experience of the ectopic migration of parasite to the subcutaneous tissue of the abdomen, which was easily treated with excision and Praziquantel medication. METHODS: A 59-year-old woman who likes eating unboiled freshwater crab was diagnosed as Paragonimiasis 15 months ago. Her symptoms were fever and cough, and she was treated with Praziquantel medication. 3 months after discharge, she visited our hospital with left pleuritic chest pain, cough with fever, and palpable mass formation on left lower quadrant of the abdomen. Wedge resection of the left lung and Praziquantel medication was maintained for a week. Nevertheless, fever persisted after the treatment. The patient received total excision of the abdominal soft tissue mass, and the fever was relieved. RESULTS: Pathologic findings of the mass showed multiple cyst and abscess formation with crystal structure which is suspicious parts of the parasite or calcified egg shells. Uncontrolled fever was relieved after the operation, and there was no evidence of recurrent Paragonimiasis and ectopic migration for 1 year follow up period. CONCLUSION: Ectopic migration of Paragonimus is rare, but multiple organ can be involved. Patient with Paragominiasis who was refractory in fever control after Praziquantel medication or surgical evaluation of the lung should be considered as ectopic migration of the Paragonimiasis.
Abdomen ; Abscess ; Animals ; Asian Continental Ancestry Group ; Brain ; Chest Pain ; China ; Communicable Diseases ; Cough ; Eating ; Egg Shell ; Female ; Fever ; Follow-Up Studies ; Fresh Water ; Human Body ; Humans ; Incidence ; Japan ; Korea ; Liver ; Lung ; Middle Aged ; Paragonimiasis ; Paragonimus ; Paragonimus westermani ; Parasites ; Praziquantel ; Rage ; Spinal Cord ; Subcutaneous Tissue

PURPOSE: The goal of this study was to develop a model of risk factors for depression in hospitalized burned patients. METHODS: Seventy-seven patients over 20 tears of age who were admitted to the Hangang Sacred Heart Hospital for burn injury, completed Structured Interview Post-traumatic stress disorder (PTSD), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain and itching after 1 month from burn. A path analytic strategy was used to develop a model of risk factors for depression in burned patients. RESULTS: Two pathways to depression were developed. 1) From sleep disturbance and then to depression 2) from burn pain to PTSD and then to depression. It was revealed that sleep disturbance and PTSD had a direct effect on depression, pain had both direct and indirect effect on depression. CONCLUSION: Sleep disturbance and PTSD are associated with depression in burned patients. The identification of two developmental pathways suggests the importance of establishing preventive interventions for depression.
Burns ; Depression ; Heart ; Humans ; Pruritus ; Risk Factors ; Stress Disorders, Post-Traumatic

PURPOSE: Burn is an unusual medical situation with limited information open to common people. This study was designed to evaluate the communication gap and different understandings between doctor and patient about burn treatment and to improve quality of the treatment. METHODS: Cross-sectional studies were done with interview and questionnaire. 25 doctors and nurses of burn ward and 50 burn patients in Han-gang Sacred Heart Hospital Burn Center were participated. To understand the communication gap and different perception between doctors' and patients' on 1) burn sequela and recovery, 2) disease course and prognosis, 3) healing environment, cost, hospitalization, 4) nurse-physician collaboration, 5) psychiatric consultation, 6) extra incentive were analyzed. RESULTS: Patients tend to expectation positive answer about their prognosis from their physician but they have recognized chronic and negative prognosis of burn treatment. Patients want to know clear and detailed explanation about their test result or treatment methods. Physicians thought that it is important to consider patients' economic status and provide different treatment principle. Short duration of hospitalization is not related to the anxiety of rehabilitation. Patients thought that nurses could manage superficial or repeated treatment. It is more likely that physicians warn the disadvantages of psychiatric consultation than patients. Both groups thought that extra incentive or gratitude money is not helpful for the doctor patient relationship. CONCLUSION: Given the discrepant views of physicians and patients on the burn treatment, physician should be aware of the discrepancies and attempts to resolve any differences.
Anxiety ; Burn Units ; Burns ; Cooperative Behavior ; Cross-Sectional Studies ; Heart ; Hospitalization ; Humans ; Motivation ; Prognosis ; Surveys and Questionnaires

OBJECTIVES: Delirium is a common postoperative complication in old adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this study is to evaluate the incidence, preoperative, intraoperative, and postoperative risk factors of postoperative delirium in spine surgery. METHODS: Seventy-nine patients who underwent spine surgery were included. Preoperative assessments included current medical illness, number of comorbid problems, and the number of medications by past medical history, medical record, and interview with patients and caregivers. Intraoperative risk factors were evaluated. Laboratory data were checked preoperatively and postoperatively. The presence of delirium was determined by the Korean version of Delirium Rating Scale (K-DRS). RESULTS: Postoperative delirium was found in patients (7.6%). There was an association suggested between older age and postoperative delirium in spine surgery (p<0.05). An association was suggested between increasing numbers of medical conditions and postoperative delirium (p<0.05). Preoperative hemoglobin, hematocrit, sodium, potassium, calcium, albumin levels and postoperative hemoglobin and total protein levels were in the delirium group was significantly lower than those in control group (p<0.05). CONCLSION: This study showed that the postoperative delirium in spine surgery is not rare and several preoperative and postoperative factors are involved in the development of delirium. This pilot study is the first prospective trial in the area of postoperative delirium in spine surgery with a small sample size and short-term period, so further research with large sample size will be necessary.
Adult ; Aged ; Calcium ; Caregivers ; Delirium* ; Hematocrit ; Humans ; Incidence ; Institutionalization ; Medical Records ; Pilot Projects* ; Postoperative Complications ; Potassium ; Prospective Studies ; Risk Factors ; Sample Size ; Sodium ; Spine*