Whenever a clinician manages the patients with depression, he may meet various prolems that make it difficult to treat them. Even though he has good skills and knowledge abut depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather tnan the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used durig pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms durig pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes folowing prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.
Antidepressive Agents ; Compliance ; Depression* ; Depressive Disorder, Treatment-Resistant ; Female ; Fetus ; Humans ; Polypharmacy ; Pregnancy ; Treatment Failure

No abstract available.
Adolescent ; Adolescent, Hospitalized* ; Humans ; Mental Disorders*

No abstract available.
Aged* ; Gallstones* ; Humans

No abstract available.
Gonadal Dysgenesis, Mixed*

The ulcerative colitis is a relatively common disease in the European and North American countries aince Dr. Wilks has first reported the cases in 1895, But in Korea, this disease is a rare entity and only a few case have been reported. However, rescently the diagnoetic methods for ulcerative colitis are much developed we have experienced 28 cases of ulcerative colitis which were diagnosed by endoscopy, barium enema exam and biopsy. Therefore a total of 28 patient with ulcerative colitis diagnosed and treated at the department of internal medicine of HYUH from June 1979 to June 1986 was reviewed. We obtained the results as follows; 1) The sex distribution assumed a ratio of 1 to 1.33 with 12 males and 16 females. 2) The age dietribution was relatively even but the majority of cases were between 5th and 6th decade (32.1%), 3) The most prominent clinical symptoms were rectal bleeding, abdominal pain, diarrhea, fever, wight loss and vomiting. 4) Significant laboratory findins were anemia, eleveited ESR, leukocytosis, positive stool OB, electrolyte imbalance and decreased serum albumin level. 5) As to the extent of disease determined by the barium enema examination and endoscopic exam., rectum or rectosigmoid colon is involved in majority of the cases (92.8%). 6) The endoscopic examination was performed in all 28 cases and showed significant findings such as ulceration, hyperemia, mucosal friability, bleeding etcs. 7) The barium enema examination was performed in 19 cases and showed positive findings such as ulceration, luminal narrowing, bowel shortening and rigidity in 17 cases. 8) 21 of 28 patients treated by medical therapy showed relatively improved but 4 of 28 patients was exacerbated or relapsed and one has expired.
Abdominal Pain ; Anemia ; Barium ; Biopsy ; Colitis, Ulcerative* ; Colon ; Diarrhea ; Endoscopy ; Enema ; Female ; Fever ; Hemorrhage ; Humans ; Hyperemia ; Internal Medicine ; Korea ; Leukocytosis ; Male ; Phenobarbital ; Rectum ; Serum Albumin ; Sex Distribution ; Ulcer* ; Vomiting

No abstract available.
Urinary Tract*

No abstract available.

Ameloblastic fibrosarcoma is an extremely rare variety of odontogenic tumor. It has not previously been reported in Korea. The tumor is composed of benign odontogenic epithelium with a mesenchymal part which exhibits the histologic features of fibrosarcoma. We have reported a case of amloblastic fibrosarcoma of the mandible in a 26-year-old man with swelling of right mandible for 2 weeks. The tumor showed yellowish ill-demarcated ulcerating mass involving right premolar and molar area. Light microscopy revealed irregularly arranged strands and islands of odontogenic epithelium surrounded by abundant mesenchymal tissue with the feature of fibrosarcoma. The fibrosarcoma cells were strong positive on immunostain for vimentin and ameloblastic cells were weakly positive for cytokeratin. S-100 and CEA were negative in both epithelial and sarcoma cells. The sarcoma cells were corresponding to fibroblasts on the electron microscopy with abundancy of RER and mitochondria and covering of basal lamina. Two types of virus like particles were distributed in the cytoplasm and nuclei of sarcoma cells. We treated the patient with surgery and chemotherapy. The recovery was uneventful and the prognosis is under observation.
Male ; Humans

Bupropion was originally developed and approved as an antidepressant but was reported to reduce the desire to smoke cigarettes. Although nicotine replacement has been the first line drug treatment for smoking cessation for many years, bupropion has comparable efficacy for smoking cessation, independently of a previous history of major depression, with less weight gain, lack of emergent depressive episodes, and improvement of SSRI-associated sexual dysfunction. Bupropion SR may be a good alternative for adult with ADHD, in addition to child and adolescent. Other trials showed that bupropion was effective and well tolerated for the treatment of various psychiatric and medical conditions including social phobia, posttraumatic stress disorder, overweight, some sexual dysfunctions, neuropathic pain, low back pain, fatigue, and etc. However, randomized, placebo-controlled studies with long-term follow-up are needed.
Adolescent ; Adult ; Anxiety Disorders ; Bupropion* ; Child ; Depression ; Fatigue ; Humans ; Low Back Pain ; Neuralgia ; Nicotine ; Overweight ; Phobic Disorders ; Smoke ; Smoking Cessation ; Stress Disorders, Post-Traumatic ; Tobacco Products ; Weight Gain

Thirty five male Sprague-Dawley rats were treated with cadmium chloride solution ranging from 0.2 to 3.2mg CdCl2/kg by intravenous single injection. At 48 hours after administration of cadmium, total cadmium, MT bound cadmium and histopathologic finding in liver, kidney, lung, heart, testis, metallothionein in liver, kidney and total cadmium in blood were examined. Tissue cadmium concentration was highest in liver, followed by in kidney, heart, lung and testis. Cadmium bound to metallothionein(MT-Cd) and ratio of MT-Cd to total cadmium were increased in liver and kidney dependently of cadmium exposure dose, but not significantly changed in other organs. On histopathologic finding, the most susceptible organ was heart in considering cadmium exposed dose, but testis in considering cadmium concentration. Blood cadmium concentration was increased with dose-dependent pattern, and significantly correlated with tissue cadmium concentration, so that we may estimate tissue cadmium concentration by measurement of blood cadmium concentration. Metallothionein in liver and kidney was increased with dose-dependent pattern, higher in liver than in kidney, and was significantly correlated with tissue cadmium concentration. However, metallothionein induction efficiency of tissue cadmium(microgram MT/microgram Cd) was greater in liver than in kidney, and reverse to tissue concentration or exposed dose of cadmium.
Animals ; Cadmium Chloride ; Cadmium* ; Heart ; Humans ; Kidney ; Liver ; Lung ; Male ; Metallothionein* ; Rats* ; Rats, Sprague-Dawley ; Testis