OBJECTIVE: To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia. METHODS: Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined. RESULTS: VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia. CONCLUSION: We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.
Deglutition Disorders* ; Deglutition* ; Diagnosis ; Esophageal Sphincter, Upper ; Healthy Volunteers* ; Humans ; Manometry* ; Pharynx ; Relaxation ; ROC Curve ; Sensitivity and Specificity ; Tongue

OBJECTIVE: This study aims to develop a new screening dysphagia questionnaire for elderly people. METHOD: Initial questionnaire for mastication and swallowing function of elderly people were composed of 20 questions. Total of 30 experts were invited to participate in the Delphi survey, including physiatrists, occupational therapists and dietitians. Modified Delphi method was performed into two rounds. Twenty young adults and twenty elderly volunteers were tested with these items and were compared with other pre-existing tests. Also, validity of selected evaluating items was tested using VFSS. RESULT: For the first round of surveys, a consensus was reached on 72.5% of the questionnaire. Final agreement was reached on 98% of the questionnaire. The results of the first round survey with the 20 evaluation items and second round showed that the content validity ratio (CVR) and stability were high enough and met the criteria of consistent agreement from a group of specialists. The final round survey following the 1st and 2nd round survey was implemented, which finally reduced to 14 items from initial 20 items. The researcher allocated the items into the 3 categories. The score of the developed item were highly correlated with that of the pre-existing screening questionnaire and time parameters of the VFSS showing a significant difference according to the score. CONCLUSION: We developed a screening tool for evaluation of chewing nad swallowing function for the elderly people. Though it is necessary to be verified through large scale clinical studies, it may be simply applicable to the elderly people with mastication and swallowing dysfunction or could be evaluated by caregivers.
Aged* ; Caregivers ; Consensus ; Deglutition Disorders ; Deglutition* ; Humans ; Mass Screening ; Mastication* ; Methods ; NAD ; Nutritionists ; Specialization ; Volunteers ; Young Adult

The current national health-insurance system of the Republic of Korea uses the negative-list method to determine benefit coverage, which includes most medical services. However, financial limitations have led to frequent conflicts between medical-service providers and the Health Insurance Review and Assessment Service (HIRA) about the inclusion of specific service-providers' practices within benefit coverage. The role of HIRA is to determine whether payments claimed by service providers are clinically valid and formulated in a cost-efficient manner. This article describes the present state and structure of the benefit system in the Korean national health-insurance system. We focus on issues of arbitrary uninsured benefits that may arise when service providers request patients to pay in full (with their approval) for a service that is not included in the benefits, according to the National Health Insurance Act. We also consider the legal treatment of arbitrary uninsured benefits in Korea and other countries. We suggest measures to improve the payment system for arbitrary uninsured benefits in Korea. Laws and regulations should be revised to cover these arbitrary uninsured benefits in a manner that can be agreed upon by HIRA, service providers, and patients.
Consensus ; Humans ; Insurance, Health ; Jurisprudence ; Korea ; Medically Uninsured ; National Health Programs ; Republic of Korea ; Social Control, Formal ; Social Security

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.
Atrioventricular Block/*chemically induced ; Boronic Acids/*adverse effects/*therapeutic use ; Female ; Humans ; Middle Aged ; Multiple Myeloma/*drug therapy ; Pyrazines/*adverse effects/*therapeutic use

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.
Atrioventricular Block/*chemically induced ; Boronic Acids/*adverse effects/*therapeutic use ; Female ; Humans ; Middle Aged ; Multiple Myeloma/*drug therapy ; Pyrazines/*adverse effects/*therapeutic use

The medical system is turning into a general health care system recently. The change in the system increases the cooperation between the physicians and the non-physicians in reality. So it is inappropriate to punish every cooperative work between the two for unlicensed medical practice control program anymore. In order to readjust the control over the unlicensed medical practice, critically dismantling and reconstructing the concept of medical treatment must be done. The three elements of the concept of medical treatment can be constructed socially in relation to disease. When this is done under social subsystems, the ideological functions of disease and medical treatment concepts can be explained. There are three aspects to the current unlicensed medical practice control program. There is a large gap between the legal judgment and the medical rationality. Moreover, the government unnecessarily has a full control over all dimensions of the medical treatment concept, and the license system only emphasizes the status, not the essence of the medical treatment itself. The dermatologists and cosmeticians' work must be divided but done cooperatively. A way to legislate this is to draw the cosmeticians into the area of medical skin treatment. Rather than solving the problem by giving cosmeticians another status, it is important for them to cooperate functionally with the dermatologists. The government should control the `cooperative division of work' between the two indirectly, so that the civil society can function on its own disciplinary mechanism.
Delivery of Health Care ; Judgment ; Licensure ; Skin*

BACKGROUND: Tuberculosis is more prevalent in dialysis patients than in the general population, and more difficult to make a diagnosis, and often leads to death, Moreover, extra-caution is needed in prescribing anti-tuberculosis medications as dose modification is frequently needed in patients with renal insufficiency. Several pharmacokinetic studies have been performed for antimycobacterial regimens in patients with renal insufficiency, including under hemodialysis. However, the anti-mycobacterial regimens of patients on peritoneal dialysis have been made based on empirical methods because of few pharmacokinetic studies. METHODS: To elucidate the pharmacokinetic profiles of anti-mycobacterial regimens for peritoneal dialysis, we measured both plasma and peritosol concentrations of anti- tuberculous drugs including isoniazide, rifampin and pyrazinamide in 9 patients maintained on chronic ambulatory peritoneal dialysis(CAPD). RESULTS: After a conventional oral dose of anti-tuberculosis medication, their plasma concentrations were in the therapeutic range, but the peritosol concentration of rifampin was below the therapeutic range. CONCLUSION: No dose adjustments are required for isoniazid, rifampin and pyrazinamide for the treatment of systemic or peritoneal tuberculosis in CAPD patients. On the contrary, oral rifampin is not expected to be effective in the treatment of tuberculous peritonitis, because of its low peritosol concentration.
Diagnosis ; Dialysis ; Humans ; Isoniazid ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis, Tuberculous ; Pharmacokinetics* ; Plasma ; Pyrazinamide ; Renal Dialysis ; Renal Insufficiency ; Rifampin ; Tuberculosis

No abstract available.
Disulfiram*

Mumps orchitis represents the most common complication of mumps infections and occurs in 5 to 37% of the populations. The most important danger is the risk of testicular atrophy up to 50% of affected testis which results in sterility. Two patients with mumps orchitis received systemic treatment with Interferon-alpha2(INF-alpha2)(3x06IU per day) for 7 days. All acute symptoms and signs of mumps orchitis disappeared within 4-7 days of INF-alpha2 therapy. No incidence of testicular atrophy was observed at the 19 and 6 months follow-up, respectively. No significant adverse effects of drug were occurred during treatment. We recommend the immediate interferon therapy, as soon as mumps orchitis manifests, to relieve clinical manifestation and to prevent testicualr atrophy and resulting infertility.
Atrophy ; Follow-Up Studies ; Humans ; Incidence ; Infertility ; Interferons ; Male ; Mumps* ; Orchitis* ; Testis

The intercourse for mutual understanding between the doctor and the patient is an essential factor of successful medical treatment. The law should confine its duties to forming conditions where the remedial discourse can be held freely and peacefully. Under the Art. 16 of the medical law, however, the structure of free remedial discourse is distorted by asymmetrically distributing the rights and obligations between the doctor and the patient.; The doctor's responsibility to treat the patient ends as soon as the recipient decides to terminate it on his or her own volition. In the case of patients requiring immediate attention the doctor and the patient should discuss the matters of the medical, ethical and political aspects of the termination of treatment with religious men or women etc. If the above mentioned is properly carried out, any decision is fully legitimated regardless of the its content.
Female ; Human Rights ; Humans ; Jurisprudence ; Male ; Volition