A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.
Colonic Diseases/chemically induced/complications/*pathology ; Colonoscopy ; Female ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Middle Aged ; Necrosis ; Polystyrenes/*adverse effects

It is essential during extracorporeal membrane oxygenation (ECMO) to extend the activated clotting time (ACT) using anticoagulants to prevent blood clot formation. Traditionally, heparin has been used as an anticoagulant during ECMO. Hemorrhaging due to systemic heparinization is considered a major complication of ECMO. A 48-year-old man was admitted due to cardiogenic shock with acute myocardial infarction. ECMO was instituted because of recurrent ventricular tachycardia and refractory shock. We used nafamostat mesilate (Futhan) as an anticoagulant to reduce hemorrhagic complications. The total bypass time was 153 h. The average dose of nafamostat mesilate was 2.64+/-1.11 mg/kg/h; the average ACT was 128.68+/-21.24 seconds. Only a few units were transfused, and there was no oxygenator failure or hemorrhagic complications. Thus, nafamostat mesilate may reduce the need for transfusions and hemorrhagic complications during ECMO.
Anticoagulants ; Extracorporeal Membrane Oxygenation ; Guanidines ; Hemorrhage ; Heparin ; Humans ; Mesylates ; Middle Aged ; Myocardial Infarction ; Oxygen ; Oxygenators ; Shock ; Shock, Cardiogenic ; Tachycardia, Ventricular

BACKGROUND/AIMS: The aims of this study were to investigate the prevalence of significant fibrosis in patients with chronic hepatitis B (CHB) virus infections and alanine aminotransferase (ALT) <80 IU/L, and to develop a noninvasive predictive model for significant fibrosis. METHODS: The 136 patients with CHB who underwent liver biopsy were recruited from six tertiary hospitals. The diagnostic value of predictors was judged using multivariate logistic modeling and the area under the receiver operating characteristic (AUROC) curve. RESULTS: Significant fibrosis was diagnosed in 97 patients (71.3%, 95% CI, 63.7~78.9%). In the training set (n = 85), the most important clinical data for predicting significant fibrosis were age and aspartate aminotransferase (AST). The AUROC of this model was 0.86 (95% CI, 0.78~0.94). The validation set (n=51), obtained from another institute, yielded similar results [AUROC: 0.90 (95% CI, 0.78~0.99)]. CONCLUSIONS: A high prevalence of significant fibrosis in CHB patients with ALT <80 IU/L was observed. A simple model that includes age and AST provides an easily applicable tool for physicians to guide the decision-making process regarding the need to perform a liver biopsy in individual patients. However, additional studies are needed to explore the model's performance in larger, independent patient populations.
Alanine Transaminase ; Aspartate Aminotransferases ; Biopsy ; Fibrosis ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Liver ; Logistic Models ; Prevalence ; ROC Curve ; Tertiary Care Centers ; Viruses

BACKGROUND: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. METHODS: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. RESULTS: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). CONCLUSION: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.
C-Reactive Protein ; Disease Outbreaks ; Heart ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Critical Care ; Korea ; Leptospirosis ; Lung Diseases, Interstitial ; Patient Selection ; Pleural Effusion ; Pulmonary Edema ; Retrospective Studies ; Scrub Typhus

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Adult ; Aged ; Area Under Curve ; Cohort Studies ; Female ; Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/diagnosis/*mortality/physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Models, Biological ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Venous Pressure

PURPOSE: A structural equation model was analysed to explore the determinants of health behaviors of university students in Korea. METNOD: Nine hundred sixty nine university students were selected by random cluster sampling from five universities located in the central area of Korea. DATA COLLECTION: The data was collected by questionnaires about demographic characteristics, stressful life events, perceived social support, perceived health status and health behaviors. RESULTS: 1. Gender showed indirect effect on health behaviors. 2. Living together with(out) family had a direct effecton health behaviors: students living with family showed more positive health behaviors. 3. Stressful life events had an indirect effect on health behaviors via perceived health status;a higher score of stressful life events was the predictor for negative health behaviors. 4. A higher score of perceived health status predicted positive health behaviors. RECOMMENDATION: Each university should be encouraged to develop a health behavior control program and health promotion program for their own university students. It would be more effective to develop health programs separately according to the demographic or social characteristics of the students. It is also necessary for the Ministry of Education to reform the School Health Act and school health policy to strengthen a health promotion program for university students. In conclusion, following studies should identify and promote the validity and reliability of perceived health status and health behaviors measurements.
Adult ; Attitude to Health ; Female ; *Health Behavior ; Health Status ; Humans ; Korea ; Life Change Events ; Male ; Social Support ; *Students/psychology ; Universities

OBJECTIVES: To estimate the value of statistical life (VSL) and health damage cost on theoretical mortality estimates due to environmental pollution. METHODS: We assessed the health risk on three environmental problems and eight sub-problems. Willingness to pay (WTP) was elucidated from a questionnaire survey with dichotomous contingent valuation method and VSL (which is the division of WTP by the change of risk reduction) calculated from WTP. Damage costs were estimated by multiplying VSL by the theoretical mortality estimates. RESULTS: VSLs from death caused by air pollution, indoor air pollution and drinking water contamination were about 0.3, 0.5 and 0.3 billion won, respectively. Damage costs of particulate matters (PM10) and radon were higher in the sub-problems and were above 100 billion won. Because damage cost depends on theoretical mortality estimate and WTP, its uncertainty is reduced in the estimating process. CONCLUSION: Health damage cost or risk benefit should be considered as one scientific criterion for decision making in environmental policy.
Air Pollution ; Air Pollution, Indoor ; Cost-Benefit Analysis ; Decision Making ; Drinking Water ; Environmental Policy ; Environmental Pollution ; Methods ; Mortality* ; Radon ; Risk Assessment ; Uncertainty

PURPOSE: This cross-sectional study was designed to explore the relationship among social support, experienced stressful life events and health behaviors of Korean undergraduate students, and validate the mediator effect of social support. METHOD: One thousand four hundred fifty-three undergraduate students were randomly selected from five universities located in the middle area of Korea. RESULT: The health behaviors of Korean undergraduates tend to have unhealthy patterns. In the case of the students living without family, experiencing more stressful life events and perceiving lower social support, health behaviors are poor. The relationship between perceived social supports, the frequency of the experienced stressful life events and the score of health behavior patterns is statistically significant. After controlling the effect of social support, the correlation coefficient between the frequency of experienced stressful life events and the score of health behavior patterns was slightly lower. The score of health behaviors between the group with an extremely high score of social support and the group with an extremely low score were statistically significantly different. CONCLUSION: Future studies need to be pursued to develop various strategies such as a health education programs and counseling programs for health maintenance and health promotion of undergraduates.
Counseling ; Cross-Sectional Studies ; Health Behavior* ; Health Education ; Health Promotion ; Humans ; Korea

P450 CYP2D6 enzyme(debrisoquine hydroxylase) is known to metabolize many neuroleptics and some genetic polymorphisms in the CYP2D6 gene were reported to be associated with tardive dyskinesia(TD). We investigeted the association of two genetic polymorphisms in the CYP2D6 gene, CYP2D6*4 and CYP2D6*10, with TD in Korean schizophrenic subjects. Subjects consisted of 71 Korean schizophrenics and TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). There were no statistically significant differences in the demographic variables of age, male to female percentage and the current antipsychotic(CPZ equivalent) dose between the grup with TD and the group without TD. But the duration of antipsychotic drug exposure was siginificantly higher in the group without TD(p=0.000, by independent t-test). The mean AIMS score in the group with TD was 11.2+/-6.6(S.D.). Genotypings ofr the presence of CYP2D6*4 and CYP2D6*10 wee done using PCR amplifications and endonuclease digestions. There were no statistically significant genotypic and alleleic associations between TD and CYP2D6*4(by chi-square tests), and between TD and CYP2D6*10(by chi-square tests). These results indicate that the CYP2D6*4 and CYP2D6*10 polymorphisms have no significant roles in the causation of TD.
Antipsychotic Agents ; Asian Continental Ancestry Group ; Cytochrome P-450 CYP2D6 ; Dyskinesias ; Female ; Humans ; Male ; Movement Disorders* ; Polymerase Chain Reaction ; Polymorphism, Genetic

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.
Adolescent ; Adult ; Aged ; Cardiovascular Diseases/*epidemiology ; Coronary Disease/*epidemiology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Rheumatic Heart Disease/*epidemiology